As the Departments of Defense and Veterans Affairs look to create a common shared electronic health record system, the VA is poised to benefit from DoD investments in a Cerner data center that currently hosts the military’s new EHR.
DoD’s system—called MHS GENESIS—leverages the Cerner Millennium platform, as will the VA’s EHR after the agency concludes contract negotiations with the vendor later this month, creating a lifetime health record that will facilitate the transition of active duty military members to veteran status.
According to Stacy Cummings, program executive officer for Defense Healthcare Management Systems, the two agencies will share a data center hosted at Cerner’s Kansas City headquarters in which “both DoD and VA data will reside in a single platform.” Cummings said the VA will take advantage of DoD’s investments in the commercial data center.
“Part of the leverage that VA is getting by their choice to use this very same system is they avoid the investment, cost and the time” that DoD has already put into the initial operating capability phase of MHS GENESIS, says Jerry Hogge, senior vice president at Leidos Defense Health.
In 2015, DoD awarded a $4.3 billion contract to prime contractor Leidos to modernize the military’s EHR system. The Leidos-led team includes consultancy Accenture, dental software vendor Henry Schein and Cerner, which provides the core Millennium capability as a software-as-a-service hosted in the vendor’s data center.
The DoD contract with Leidos includes several services, including hosting MHS GENESIS in a separate enclave, incorporating significant cybersecurity enhancements to protect the data, as well as physical and virtual separation from commercial clients.
DoD modified its contract with Leidos in 2015 to meet EHR hosting requirements that the military said could only be met by a data center owned and operated by Cerner.
“It was a design feature of the original contract, where the government left open its hosting choice,” recounts Hogge. “It could have been a public service like Amazon Web Services, or a (Defense Information Systems Agency) mega center, or it could have been the winner of the contract—in this case Cerner—to provide hosting services. The customer allowed for that choice to be made.”
However, according to DoD, Cerner’s data center enables direct access to the vendor’s proprietary data that would otherwise not be possible in a government-hosted environment.
“The proprietary data consists of quantitative models and strategies which are the result of extensive Cerner-funded research and development efforts conducted over 15 years,” contends the military. “The models are based on analysis of clinical, operational, and financial data associated and incorporate vast amounts of actual longitudinal patient data and information collected through other Cerner applications.”
Despite being hosted in a separate enclave, anonymized DoD population health data can be analyzed with the rest of the Cerner client patient population, enabling trending and other healthcare analytics. VA and DoD provide healthcare services to essentially the same patient population. In fact, within the last seven years, about 5.7 million patients have received care at both a VA and DoD facility.
Hogge adds that the cybersecurity architecture for the new DoD EHR is “one of the most effortful parts of the project” to ensure that the deployment is consistent with military requirements. “It’s not quite the same in the (Cerner) data center as a commercial deployment because of those connections to the DoD’s networks—but, it’s being done very carefully and in a very secure way,” he contends.
Cerner President Zane Burke notes that MHS Genesis is the first commercially available off-the-shelf EHR solution that is connected to the DoD system. As a result, Burke says “there’s quite a high level of scrutiny from a cybersecurity perspective.”
DoD’s hospitals and clinics are connected to the Cerner data center over a private network called the Medical Community of Interest (Med-COI). Hogge describes this secure, interoperable network for DoD medical community information technology communications and operations as an important “separation from the public Internet.” Burke calls it a “private military cloud.”
“The government has a unique way of configuring their systems and working with their patients,” observes Jon Scholl, president of Leidos Health Group.
So far, DoD has implemented its Cerner system to four military sites in the Pacific Northwest as part of the initial operating capability phase for MHS GENESIS. VA Secretary David Shulkin, MD, has said that the agency plans to align the deployment and implementation of its EHR with the rollout of DoD’s own system—starting in the Pacific Northwest.
Overall, VA will capitalize on DoD’s data hosting, standard workflows and enhanced cybersecurity, as well as advanced data analytics for providing visibility into military-specific health patterns based on combat and geographic exposures.
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