How did the Department of Defense decide upon Cerner, anyway? That's a question healthcare industry insiders have been wondering since the DoD shocked so many expecting Epic to win the contract.

During a pre-announcement conference call with a fistful of reporters, Defense officials revealed some of the prioritized criteria that went into their final decision.

"We did extensive analysis of alternatives," said Frank Kendall, DoD under secretary for acquisition, technology and logistics. "We had the opportunity to do competitive procurement, and our analysis said it would be much cheaper."

Part of that analysis involved pulling together clinicians – doctors, nurses, dentists – with IT people and leadership, said Chris Miller, executive officer for DoD's Healthcare Management Systems Modernization and Integrated Electronic Health Records.

Kendall, Miller and Jonathan Woodson, MD, assistant secretary of defense for health affairs, outlined important factors – without putting them in order – critical to the agency's decision.

1. Modifications. Just about any software installation of this size is going to require some heavy-duty tailoring and customization, so the DoD "wanted to do minimum modifications to the software," according to Kendall.

2. Vendor lock-in and upgradability. It will certainly take until the DoD actually has Cerner up and running in at least the planned eight Pacific Northwest test sites to really know if they're not locked in, but the thinking was to pick the team that best demonstrated an ability to work with modular capabilities from other vendors, just in case the DoD opts for any in the future.

3. DoD owns the data. This is a big one. "Taking our time to do this right, we wanted to make sure we contracted properly," Miller explained. "We own 100 percent of our data. There are a lot of nuances. We also have all the data rights to deal with training," as well as the "ability to move from one vendor to another."

4. Training. As is often the case in massive software implementations, training eats up a lot of the costs and, in the DoD's case, "over 25 percent of the contract goes to training users and clinicians," Miller said. "An EHR is not just a simple piece of software."

5. Cybersecurity. Mastering the obvious, of course, the U.S. military had to make security a paramount consideration. Cybersecurity was an explicit piece of the RFP, Miller said, and Cerner had to scan its software and report all vulnerabilities back to the DoD. "Cybersecurity risk is something we take very seriously."

6. Interoperability. Cerner's EHR will be what Woodson called "an important enabler of sustaining care anywhere people might serve, a vital piece of care coordination," that will reside in more than 1,000 sites around the globe and that means the commercial software must interoperate not only with VA but also with the private sector healthcare entities that conduct as much as 70 percent of service-member's care.

7. Data blocking. An increasingly contentious topic of late, particularly since ONC issued its report to Congress spotlighting how vendors and providers are interfering with the exchange of health information, this builds on the DoD owning its own data and interoperability requirements. Patient information must be able to flow to the VA and private sector, and the DoD is looking to the private sector to increase its efforts as well, and Woodson said in a previous Healthcare IT News article that the DoD will be both advacning public prepareness and looking to the private sector to follow suit.

Even though it's not a comprehensive list, does that jibe with your purchasing criteria? What did the DoD miss? 

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