DOD health agency embraces data standardization

The Defense Department's planned $11 billion acquisition of a commercial, electronic health record system has gotten a lot of press, but it's only part of the story of the massive IT and business transformation of the military health system.

Annual spending on health care by the Defense Department is budgeted at $53 billion for the current fiscal year, and is expected to double by 2030. As head of the Health IT Directorate for the Defense Health Agency and CIO for the Military Health System, Dave Bowen is helping to lead a process years in the making to unify health care resources into a single, cohesive system, pull together IT organizations, and standardize data collection. This is essential, he said, because data is essentially what runs the health system.

"Health care costs are expected to significantly impact the Department of Defense. Obviously that's not a tenable situation," Bowen said during a panel discussion at an ACT-IAC Health IT Forum in Washington, D.C., on Sept. 24.

In a sense, the health record procurement is the most visible aspect of a broader data standardization effort at DOD, which took shape with the establishment in October 2013 of the Defense Health Agency as a military-wide health system delivering care, logistics, facilities, and more on a shared service basis to all the branches of the armed forces.

Bowen, who was new to military culture when he started his job, said he was "amazed that the services do almost nothing the same. They do almost everything differently." The job of unifying these disparate cultures is a major challenge. Among the biggest near-term issues are getting a handle on what data is collected, how it is accessed and where it is sent.

"Frankly, right now we're not sure of all the places where we're sending [data] within the DOD. We've done some analysis which shows some systems are sending some data to other systems, which in turn go through some machinations and send the same data back to the first system. Clearly we've got a spaghetti pile of data transmission that we've got to work through," he said.

To get a handle on things, Bowen's organization is asking the surgeons general of the services to approve a data governance capacity that will "oversee the collection, dissemination and designation of data," Bowen said. That will establish what the system of record is for a piece of data, what systems need it, and how the systems work together.

Even as Bowen tries to get a handle on clinical data through the EHR and other standardization efforts, there's also the financial side to think of, and more than 400 hospitals and clinics with their own IT infrastructures. "We've got to have data architectures that enable us to consolidate and combine that financial data," Bowen said.

Vendors are expected to submit their bids for the EHR project early next month, with a final selection anticipated in June 2015.