The Defense Department has been thinking about how to upgrade and replace its electronic health record system for a very long time. But in the eight years that have passed since those discussions began in earnest, a lot has changed in terms of the capabilities of commercial EHR systems.

To heavily paraphrase Lt. Gen. Douglas Robb, the director of the Defense Health Agency, DoD is no longer thinking of the modernization as something akin to an IT upgrade from Windows XP to Windows 7. The market research it conducted in the lead-up to the formal solicitation it issued to buy a new commercial EHR last week has led it to conclude that the project could have a transformative impact on the way it conducts the rest of its operations in the healthcare sphere.

“The power of what this could do and deliver for us is basically unknown,” Robb told AFCEA’s annual Joint Warfighter IT Day last week.

He noted that while, yes, DoD does already have an electronic health record system and was one of the first large healthcare systems to create one, the current system,

AHLTA, is more-or-less just a digitized version of what health providers have kept on paper for centuries, and focused mostly on a relatively narrow set of data on patient treatment.

“Now it’s going to give me a whole set of clinical support tools based on patient history and other data, but at the same time, it’s going to feed my logistics system, it’s going to feed my automatic resupply in surgery, it’s telling me what I may need for personnel in support of what’s scheduled to come into the operating room the next day. That’s why this is so complicated. It’s not just a digitized version of your health record anymore. It’s a whole business support tool, which has really only come about in the last two-to-three years.”

Recent advances in the commercial health IT field are one reason DoD officials say that whatever they end up buying, they’re going to insist that end users resist the temptation to demand government-specific or site-specific modifications to the end product.

“Our message to folks is that we want to buy off-the-shelf, and we do not want to highly customize this thing, because then you get into this vicious cycle of having to keep up and continuously writing software,” said Christopher Miller, the DoD program executive officer in charge of the EHR procurement. “We want to drive adoption by getting our own people excited, because what we want is for people to innovate using these tools and make the overall outcomes what we need them to be.”

Miller says his procurement team spent a lot of time in private-sector clinical facilities in the lead-up to the RFP, asking questions about their own EHR implementations.

“One thing that got reinforced is you’ve got to include the business side. This can’t just be about the EHR. I got it beat into my head that you’ve got to address the change management and training piece,” he said. “Standardization is critical. I have over 1,000 sites I have to deploy to. If we let each one of those do their own thing, this thing will fail.”

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