Is The Military’s New Health Records System Already In Trouble?

The Department of Defense (DoD) and contractor Cerner are coming off an eight week break in the initial deployment of what’s planned to be a worldwide health care records system. The team stopped work to address glitches in system performance and contend with negative user feedback. But officials in charge of the deployment of the MHS Genesis system said the pause was planned as part of the rollout, initial complaints were expected, and DoD still expects to complete the $4.3 billion system by 2022.

MHS Genesis, DoD’s latest effort to create a unified electronic health record (EHR) for more than 9.4 million recipients under the department’s care, was first deployed at Fairchild Air Force Base in Spokane, Washington in early 2017, and went live at Fairchild and three other bases in the Pacific Northwest in November. It’s being deployed under the DoD Healthcare Management System Modernization (DHMSM) program.

The system encountered some challenges from the start.  Following an operational assessment conducted by DoD’s Director of Operational Test and Evaluation (DOT&E) in May and June last year, the implementation team addressed deficiencies that were identified. But DOT&E said that users rated the system’s usability as “low,” citing inadequate training, outdated manuals, longer workflows compared with the previous system, and “the need for multiple roles to accomplish mission tasks.” The assessment also found a significant number of cybersecurity vulnerabilities.

A recent report in Politico was more damning, saying that problems with the system reduced the number of patients being treated, caused prescription errors, and made clinicians worry that they might harm patients (several at one facility reportedly quit because of the concerns). DoD’s cybersecurity requirements also created 10-minute login times and forced log outs, according to the report.

Defense health and contractor spokespeople pushed back at the report, acknowledging the problems and a lack of user training, but saying that early difficulties are expected with a project of this size. The purpose of a step-by-step rollout is to discover and correct system’s shortcomings before wide deployment, Maj. Gen. Jeffrey Clark, the Defense Health Agency’s deputy director for operations, said in a conference call reported by Federal News Radio. A spokesman for Leidos, which is leading the deployment of Cerner’s system with Accenture Federal Services in the Leidos Partnership for Defense Health, told the Federal Times that the system has made significant improvements, and that its team was correcting the problems.

MHS Genesis is intended to provide a single EHR that integrates a range of services in addition to direct doctor-patient interactions. “In medicine today, we leverage a lot of different skill sets on a healthcare team,” Air Force Surgeon General Lt. Gen. (Dr.) Mark A. Ediger said during the system’s introduction at Fairchild. “[MHS Genesis] goes well beyond the traditional doctor-patient interaction, and leverages skill sets such as nutrition, exercise physiology, and disease management. It’s a very collaborative tool that allows the team to share a common picture.”

Keeping a close eye on the Genesis rollout is the Department of Veterans Affairs, which last year agreed to use Cerner’s system in an effort to fulfill the long-held and to date fruitless vision of an interoperable DoD/VA health record. Expensive efforts at a unified record have been launched, abandoned in favor of separate systems, and now brought together again.

VA, which has said the MHS Genesis deployment could cost at least $4 billion, plans to deploy the system in 48 waves, starting with initial operating capability deployment at several sites by the end of 2019.

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