Changes to the original contract for modernizing the Department of Defense’s electronic health records contract have been formalized, enabling Cerner Corp. to host data from the records of service personnel.

Last week, the program office of the Defense Healthcare Management System Modernization (DHMSM) posted a formal modification of the contract, originally award to a team of vendors led by Leidos and Cerner, to allow the EHR vendor to provide hosting services for the data.

The program office’s “justification and approval” for modifying the DoD EHR contract to include sole-source Cerner data hosting services are estimated by the government to cost $50.7 million over 10 years. However, the additional expense of the hosting services is not expected to add to the price of the original $4.3 billion contract.

In fact, the Pentagon expects to save $60 million using the new hosting approach, because doing so will spare it the expense of developing a solution hosted by the Defense Information Systems Agency (DISA), says David Norley, director of government affairs and acquisition management for the Defense Healthcare Management Systems. “We’re getting a higher level of service at reduced cost,” Norley says.

David Norley
David Norley

The change in hosting approaches was not anticipated last year, when the DoD awarded the contract to the Leidos-Cerner team to modernize the DoD’s electronic health record system. Military acquisition officials were tasked with picking the best possible EHR solution, Norley says.

However, soon after the contract award was announced in late July 2015, the Pentagon realized that requirements to host the EHR could only be met by data centers owned and operated by Cerner. The original request for proposals called for “traditional” government hosting at DISA computing facilities,

The DHMSM program office issued a request for information in September 2015 to determine what commercial EHR hosting options were available to meet its requirements. While submissions in response to the RFI revealed that some vendors could provide solutions to meet basic requirements, none of the responses indicated that vendors could provide direct access to the necessary proprietary Cerner data, critical for the military to enable the full functionality of the EHR.

Cerner’s proprietary data, which includes anonymized patient data from the vendor’s entire customer base, consists of quantitative models and strategies that “are the result of extensive Cerner-funded research and development efforts conducted over 15 years,” a February 3 FedBizOpps announcement indicates.

Other hosting solutions would have limited the military to a DoD-only data set, precluding access to Cerner models the DHMSM EHR access to Cerner models—based on the analysis of clinical, operational, and financial data—as well as vast amounts of longitudinal patient data only available as a Cerner-managed service.

"When it was all said and done, we evaluated the data hosting solution that made the most sense."

“What Cerner hosting the data does for us is it gives our clinicians access to advanced analytics that will run across a population spectrum that is a lot more meaningful,” Norley says. “Without using this Cerner data hosting, there was no way to get access to the additional people on the Cerner system that are outside DoD.”

As a result, according to Norley, machine learning and computational statistics enable predictive analytics and decision support for the military’s clinicians that can directly and positively impact patient outcomes.

“In the time since we envisioned the RFP and since we awarded the contract, the private sector has made a significant inroad into federal government and DoD data hosting. It’s not revolutionary but it’s much more accepted now,” he adds. “The bottom line is, when it was all said and done, we evaluated the data hosting solution that made the most sense afterwards because we didn’t want to make it a part of the selection criteria—we simply wanted the best electronic health record.”

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