NIH looks for new EHR to replace its 20-year old legacy system

The National Institutes of Health (NIH) is planning to replace its decades-old legacy Electronic Health Record, and looking at how a new EHR could help accelerate its use of artificial intelligence tools. 

NIH’s Clinical Center in Bethesda, Maryland, the nation’s largest hospital devoted entirely to clinical research, is looking for a replacement for the Clinical Research Information System (CRIS), its EHR that’s been in place for more than 20 years. 

Jon McKeeby, the chief information officer at the NIH Clinical Center, said the agency is looking to secure funding — about $150-200 million — in the next six months and the acquisition process for a new EHR. 

“This is a level of fragility and complexity. It was based on best-of-breed 20 years ago. That was the way to do an EHR. And it’s made it very complex and very dependent on specific people, specific skills, so it’s very difficult to maintain,” McKeeby said Wednesday during a panel discussion at AFCEA Bethesda’s Health IT Summit. 

McKeeby said about 40 employees out of his IT team of 120 are at retirement age, and that the agency risks losing institutional knowledge about the inner workings of their legacy EHR as IT personnel retire. 

McKeeby said NIH is currently working with the Mitre Corporation to write the requirements and the performance work statement that’ll serve as the foundation for an eventual request for proposals. He said NIH so far has listed at least 1,000 requirements for its new EHR. 

“It’s going to be open to every vendor, even the existing vendor, but we need to move to a more integrated model, so that’s the goal,” he said. 

As part of planning for a new EHR, McKeeby said the NIH needs a health record that can keep up with the pace of emerging technology. 

“The problem with the EHR for the last few years is that we’re trying to replicate a paper medical record. Now we have all the tools to make it so we can be more visual, interact with it, but also have it create summaries, and also predictive models to help us in health care,” he said. 

McKeeby said that a new EHR should help NIH accelerate its use of AI tools, and added that AI “needs to be a major part of the clinical decision-making.” 

“Health care data is messy, and I think AI gives us the ability to visualize it, to do natural language processing, summarize it, make more use of it and take it beyond where it has been. We’ve been very static — health care data is very unstructured. There’s some structure to it, but it’s really unstructured, and we haven’t really utilized it,” he said.  “I think in the next five years, we’ll go leaps and bounds with AI in electronic health records — at least, that’s my hope.” 

However, McKeeby said new technology like AI will require a new approach to implementation. 

“My fear is we’re going to continue to build things the way we always do, we build it and we’re done. As more data comes, and the models learn more, you have to validate what the model was — and you have to continuously do this. You have to continuously watch and monitor it. We’re not good at that,” McKeeby said. “The government is not good at continuously monitoring things that we built. Once we build it, we’re done. We move and we build the next thing. And we cannot do that. So that’s my caution.” 

The IT group at the NIH Clinical Center has managed the legacy EHR since 1981. But McKeeby said selecting a new EHR is an “organizational project” that’s going to require input from all corners of the agency. 

“An EHR is not an IT project. It used to be, because nobody else would take it up. But it’s an organizational project. So how do you get everybody in the organization to be on the same path, on the same journey for that project? And it’s a lot of conversation, it’s a lot of recruitment. It’s a lot of cheerleading. It’s a lot of pulling everybody in, so they don’t think of it as an IT project,” McKeeby said. 

The Department of Veterans Affairs started rolling out a new EHR from Oracle-Cerner in 2020. But implementation of the EHR is on hold, as the vendor and the VA deal with persistent outages and lags in the system. VA clinicians have also given the new EHR low favorability scores, and Congress has raised patient safety concerns. 

The Oracle-Cerner EHR is currently running at five small and medium-sized VA medical centers. Full deployment would bring it to more than 170 VA medical facilities.

The VA’s ability to resume the EHR rollout will depend, in large part, on the success of the system’s launch in March 2024 at the Capt. James A. Lovell Federal Health Care Center in Chicago.

The facility is jointly run by the VA and the Defense Department, which is much further ahead in its own deployment of the same Oracle-Cerner EHR. VA cites interoperability with DoD’s health records as one of the top benefits of moving to a new EHR.

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