Bowen: Consolidating health IT about culture, not tech

As the Department of Defense gears up for a planned $11 billion acquisition of an electronic health record system, the top tech official at the Defense Health Agency said the biggest hurdles to a unified system are cultural, not technological.

The move to the single health record is a big part of a massive drive to eliminate IT redundancies and other inefficiencies in the Military Health System that is projected to save $550 million in annual operating budgets by fiscal 2021. David Bowen, director of the Health Information Technology Directorate for the Defense Health Agency and CIO of the Military Health System, said every system and application that is phased out in the name of efficiency has its fans who will be suspect about migrating to a new system or working inside of a new organization.

The Defense Health Agency was created by Congress in 2010 to standardize health care across the military services. In 2011, it adopted a shared services plan for pharmacy, logistics, health operations, facilities and health IT.

"This is more about change management than it is about technology," Bowen said at the Health Information Management Systems Society in Washington, D.C., on June 18. "It's a business transformation project and a cultural transformation project."

As an example, Bowen said DHA is only now concluding an 18-month project to winnow the number of e-learning platforms it uses from 26 to one. "That is a very radical project for the Defense Department," Bowen said. "It means people have to give up stuff that they're used to using.

The changes are also playing out in infrastructure and ops, with DHA in the process of consolidating data centers and help desks. "We have three or four of almost everything that's out there," Bowen said. "We're embarking on a process of change management and standardization that many of you in the commercial sector have already done," he said.

So far, the effort appears to be paying off. According to Bowen, DHA was scheduled to report about $6 million in savings at this point in its modernization effort. As of about a month ago, DHA had identified $24 million in savings.

Despite the need for efficiencies, the military still makes unique demands on its health system. In an effort to guarantee that health records follow personnel from war zones all the way through the system as needed, DOD is testing a mobile connectivity device that can be dropped into a battle space, detect Wi-Fi, 4G, 3G and satellite, and use the available networks to transmit information. The goal, said Bowen, is to make sure the "electrons arrive before the patient."

The final request for proposals for the multiyear Department of Defense Healthcare Management Systems Modernization health record project has been pushed back to August, said Bowen. It had previously been due to go out in July.