Pentagon’s health IT spending: EHR, cybersecurity and telehealth

In its recently released FY17 budget request, the Department of Defense will be modernizing through a series of health IT initiatives — with electronic health records, or EHR, topping the list. 

Other top IT modernization projects include battlefield medical information systems, improving cybersecurity in medical devices, telehealth programs, and greater interoperability with non-DOD medical partners.

Most of the health IT funding to pay for these programs comes from the Defense Health Program, which funds operations and maintenance expenses, research and development and procurement for both the Defense Health Agency and any service branch needs that fall outside of DHA’s purview.  

With cybersecurity being a major driver, DOD is specifically looking at the security of medical devices that are networked but were not designed with cyber protection in mind. A hacked pacemaker or diagnostic tool in a military health facility is a frightening prospect and underscores the need for improved device security. 

Telehealth also presents a number of security challenges, as DOD works to take distance out of the healthcare equation. Telehealth increases the number of devices connected to DHA’s network and moves the network further out and into people’s homes – where they may not be securing their own data properly. Therefore, network protection solutions are going to be increasingly important, particularly when it comes to mobility. 

Another priority for FY16 and FY17 is in infrastructure upgrades, especially with the introduction of the Medical Community of Interest, which is an enterprise virtual private network service, providing access to authorized users of information from DOD and the Department of Veterans Affairs.  

Military Health System – Beyond the DHA

To understand how (and where) defense health IT money is being spent, it’s important to look at the overall structure of the Military Health System, which is much more than just the DHA.

The office managing the new EHR is actually not in DHA, but in the Program Executive Office for Defense Healthcare Management Systems, a standalone health IT acquisition organization answering to the Office of the Secretary of Defense. Within its portfolio is the new $9 billion EHR system as well as battlefield medical IT systems. 

The military branches, namely Army, Navy, and Air Force, retained their own their own internal medical commands, and about half of the defense health IT budget still flows through DHA but is controlled by these organizations. 

Over the next few years expect more and more funded requirements to be centrally managed out of DHA, including the new EHR. 

Despite this transition, the military branches are telling industry that it’s important to not forget their unique clinical environments. How some health IT solutions or processes that work for an Army medical requirement may be a lot different than those for Navy or Air Force. 

Then there is the DHA, where the vast majority of IT programs reside. 

DHA’s Health IT Directorate is where health IT programs for DHA are managed. Expect all defense health IT programs to eventually run out of this office, which is embarking on an effort to bring the Joint Information Environment, or JIE — a defense-wide IT collaboration — to health IT. 

That will entail standardizing its infrastructure down to the desktop level while the new EHR is rolling out. 

Ultimately, the directorate plans to create a centrally managed network with desktop management and expanded cloud usage. The goal is to improve access and consistency for healthcare providers and beneficiaries no matter the location. To that end, expect to see associated requirements for virtualization, network security, and voice, video, and data solutions over the next several years. 

EHR Capability by December

The new EHR will be the main priority of the next couple of years, as part of the DOD Healthcare Management System Modernization program. This program will acquire and support deployment, implementation, and sustainment of a commercial EHR system, replacing DOD legacy Military Health System clinical systems.

Initial operating capability for the modernization program is anticipated by December 2016, with full deployment by 2022. 

The FY17 request for this initiative is $458 million with 82 percent of planned spending, or $379 million, set aside for capital expenses. The program will be looking to purchase solutions for healthcare administration management, healthcare delivery, logistics, supply chain management, data integration and virtualization in developing and sustaining the program.

Comprehensive Patient Information in Battlefield Conditions

As part of its healthcare vision, DOD wants to make sure healthcare professionals have the same access to information on the battlefield as they would at a major stateside hospital. The Theater Medical Information Program – Joint Increment 2 and the new Joint Operational Medicine Information Systems umbrella program, or JOMIS currently serve that purpose. Total funding requested for FY17 exceeds $85 million, a 35 percent increase over last year. Planned funding for capital expenses is $25 million in FY17, compared with just $12 million last year. 

Right now, multiple systems govern how medical information is tracked and documented from the battlefield point of injury to a major hospital. Soon, that family of theater medical information systems will be phased out or replaced by the new umbrella program. 

JOMIS will be a scaled-down network, localized and often disconnected. For example, if this capability is needed in a remote region of Afghanistan, it will be pre-populated with the data it needs. 

All of this forward-thinking IT investment within the DOD, however, is being done against the backdrop of growing pressure on budgets overall — and what is expected to be a major internal scrub across the entire IT environment within the Military Health System. Program managers will be taking a hard look at IT investments — searching for readiness and where costs can be reduced.

Lloyd McCoy Jr. is a Market Intelligence Manager with immixGroup (an Arrow Electronics company) which helps technology companies do business with the government. Lloyd focuses on Defense Department agencies as well as public sector cybersecurity. He can be reached at Lloyd_McCoy@immixgroup.com or via LinkedIn at www.linkedin.com/in/lloydmccoy.