Medical Electronic DoD Integrated Core System (MEDICS)

The DoD is seeking to deliver to the warfighter an electronic health record (EHR) with the most capability in the shortest period of time for the least cost, through the acquisition of an EHR system (EHRS). The DoD is seeking to acquire an open, modular EHRS utilizing standards-based / non-proprietary interfaces. The scope of this anticipated effort is to replace DoD legacy electronic health records systems (e.g., Armed Forces Health Longitudinal Technology Application (AHLTA), Composite Health Care System (CHCS), and Inpatient System Essentris) with a Generation 3 or better EHRS for clinical and business applications. When fully implemented, the EHRS will provide a single authoritative source of health information for DoD beneficiaries; help improve the health of our population; improve patient safety and quality of care provided; help control health care costs; and contribute to the medical readiness for our military. The EHRS will impact DoD's direct care population of more than 3 million beneficiaries, and 70,000 clinicians who practice in 56 hospitals, 364 medical clinics, and 282 dental clinics. The EHRS will maintain, and support enhancements to, ongoing data exchange between DoD and the Department of Veterans Affairs (VA), and all external partners. The Government is interested in capabilities and approaches to an EHRS, specifically regarding the implementation of an EHRS core of a Best of Suite (BoS) application, which would be followed by the addition of Best of Breed (BoB) applications until full capability is deployed. The DoD would like analyses, alternatives, timelines, and recommendations as to this approach. For the purposes of this RFI, the DoD has defined the EHRS core as containing, at a minimum, the following components: - System Management: Includes support for security (while balancing the need for legitimate access), identity management, disaster recovery, and business continuity - Interoperability: Ability to communicate and interact with other systems - Data Model: Permanent data store that guarantees that information is stored for the legally required time and can be retrieved rapidly and flexibly - Clinical Workflow: Support for the processes involved in clinical care as well as the information needed - Clinical Documentation, Document Management, and Data Capture: Capture all clinically relevant information at the point of care - Clinical Display / Dashboard (part of clinical applications): Present data in a meaningful manner that contributes to the clinician's ability to use the data effectively - Clinical Decision Support (CDS): Ability to incorporate rules and decisions - Order Management (including Computerized Physician Order Entry or CPOE): Support a variety of mechanisms for entry and management of all types of clinician orders The Government is interested in an assessment of this definition of the core in light of best practices and any variances from the interested party's core. The operational and technical environment that the DoD's legacy EHRs operate in is described as follows. The DoD has a tiered healthcare delivery network composed of academic medical centers, community hospitals, and stand-alone health and dental clinics, that are supported by the full range of administrative, logistics, and transportation services. It is a global enterprise that must also operate in an austere and expeditionary environment (e.g., combat zones and areas experiencing natural disasters). The work force is composed of military, government civilian, contractor support, and volunteers. The patient population is highly mobile and may present at any of the DoD's healthcare fixed and expeditionary facilities around the globe. Patients are typically Service members and their dependents, although there are special cases that do not fall into these categories. Care is delivered in two (2) ways: (1) the direct care system provides healthcare to DoD beneficiaries in DoD facilities; and (2) the purchased care system provides healthcare to DoD beneficiaries in contractor facilities. Approximately 60% of healthcare is delivered in the purchased care network. DoD requires the capture of this data from the private sector made available to the EHRS using Health Information Exchange (HIE) standards and best practices. The technical environment supporting the EHRS is currently composed of 101 host sites operating the CHCS order entry system (e.g., Laboratory, Radiology, Pharmacy, Patient Administration, Managed Care, Records Management, etc.), a centralized instantiation of the AHLTA clinical note system, with a hospital-based inpatient system. According to Gartner's Generation definitions, this combination of healthcare systems is considered a Generation 2 EHRS. The military services use a DISA provided single logical network on which the EHRS will operate. The DoD desires a regional data storage architecture with virtualization sites placed closer to the direct care facilities. An n-tier architecture is envisioned with a data layer, a Service Oriented Architecture (SOA) / Enterprise Service Bus (ESB) services layer, an application layer, and a user experience (UX) layer for the graphical user interface (GUI). The DoD desires open and standardized application program interfaces (APIs) to the EHRS core and applications, and open access to the data and data model. The DoD desires a common and configurable UX that can also be used with the VA EHRS. The DoD healthcare data must be interoperable with the VA, and vice versa, supporting the care delivery to shared or transferring patients. The VA data can be normalized and standardized using the 3M Healthcare Data Dictionary (HDD) and other appropriate standards. The DoD anticipates that the overall replacement EHRS effort may include, but not be limited to: (1) system and software engineering; (2) system integration; (3) installation, testing, and deployment; (4) lifecycle logistics support to include user training; (5) system and data hosting; (6) operations and maintenance (O&M) support; and (7) business intelligence and research. (See attachment for additional information)