When, at about 5 PM eastern time on Thursday, the Department of Defense (DoD) announced that it had awarded a massive contract worth billions of dollars, for the implementation of a commercially available electronic health record (EHR) solution, to the Kansas City-based Cerner Corporation, over its rivals, the Verona, Wis.-based Epic Systems Corporation and the Chicago-based Allscripts, the reveal capped months of speculation. Those three EHR vendors and their partners—Cerner had partnered with Leidos and Accenture Federal, while Epic had teamed up with IBM and Impact Advisors, and Allscripts had been working with Computer Sciences Corp. and Hewlett Packard—were vying for a contract that begins with $4.3 billion on the table, and, before it is completely fulfilled, could yield as much as $10.5 billion to the main EHR vendor involved (now revealed to be Cerner), though some DoD officials have dismissed that figure as being at least a few billion dollars too high.
In any case, the Cerner, Leidos, and Accenture Federal folks, once they finish uncorking champagne bottles and toasting their success, will face a mountain of challenges. Some of the skeptics out there in the healthcare IT world serious doubt that the senior leaders of the DoD and the Veterans Health Administration can pull this off. After all, many years were spent trying to essentially self-develop interoperability between the DoD and VA health systems, to no avail.
So there are a bunch of major questions that need to be answered about this contract, and in truth, no one has the answers—no one—right now But over time, they will inevitably be revealed. In no particular order, they are:
- Do Cerner and its partners have the intellectual, strategic, tactical, and personnel capability to successfully fulfill the terms of this contract? One simply must assume that the DoD leaders who evaluated all the major proposals made the right decision in this case (because if they didn’t, heaven help everyone involved!).
- Will Cerner and its partners be able to navigate the office politics and fields of cultural landmines facing them as they go forward into this huge new venture? The military and the Veterans Administration are famous—perhaps “infamous” might be a better term—for their politics, their fiefdoms, their internecine struggles, and their intrigues.
- Given the size and scope of this broad project, or set of projects, will Cerner and its partners find a pathway forward that combines agility, speed, and breadth in ideal proportions? Clearly, project management success will be a large piece of the core of overall success in this huge initiative; conversely, failure along the project management dimension could be crippling. Remember, this contract is expected to play out over 18 years. In healthcare IT terms, that is a lifetime (or maybe two or three lifetimes).
- Interoperability and health information exchange capability: another vast area of consideration. Sources indicate that senior DoD officials made it one of their most important criteria that the winning contractor be able to assure them of interoperability with external clinical information systems, since 60-70 percent of the care of members of the military and veterans is delivered outside the confines of the DoD’s care sites and the Veterans Health Administration.
- Ease of implementation: Frank Kendall, DoD Under Secretary for Technology, Acquisition and Logistics, has been quoted in the media as stating that he and his colleagues were looking for an EHR solution that required minimal modifications.
There is so much in this new, immense contract that cannot be known right now, and even much that will not be known for a long time. It will be fascinating to see how all this plays out. No doubt, whatever the end result is, will also impact the civilian healthcare system, as nothing this big has ever been attempted before (the closest to this being the implementation of Epic’s core EHR across the Kaiser Permanente health system several years ago).
Never before has the phrase “stay tuned” been so pregnant with meaning. It really will be fascinating to see how everything plays out in the coming years.
