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 But DOT&E said that users rated the system’s usability as “low,” citing inadequate training, outdated manuals, longer workflows compared with the previous system, and “the need for multiple roles to accomplish mission tasks.”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.

  1. Anonymous | - Reply
    It's going to be hard (impossible) to manage a monolithic application with the varied needs of DoD. Enterprise software has moved on from this model to a microservices model. What needs to be monolithic is the patient's "system of record", a distributed source of a single "view" of patient state. DLT (Distributed Ledger Technology) is making this a reality. Then the "front-end" to manage DoD's needs can be designed with very little disruption between the parts.
  2. Anonymous | - Reply
    This isn’t difficult. Simply turn on the new system and turn off the old system at each site in a coordinated fashion. If legacy data is needed for specific patient populations, utilize the joint legacy viewer for that information through a portal. Again- the bureaucracy on DoD health has to stop. Patient care is the same as commercial healthcare. There is no need to delay this action any further. Will someone in congress or the administration please mandate that a 3rd party come oversee these milestones.
  3. Anonymous | - Reply
    Maybe doomed from the beginning when LEIDOS was awarded the DOD’s EHR contract. LEIDOS just happens to be the company (formerly SAIC) who created the legacy systems that are being replaced (CHCS, AHLTA). This isn’t a “fresh” start for the DOD, whether they know it or not. DOD’s institutional memory may be shaping the subcontracted CERNER’s EHR into something that resembles the current system and functionality. This takes the “off-the-shelf” concept that was the primary reason for choosing an existing market EHR and essentially “breaking” it. Prior to the LEIDOS award, there was very little input from the “worker bees” who see patients day-after-day and utilize the DOD EMR. Input from senior military medical officers who’ve been out of clinical practice for years or have very limited clinical time and selecting specialty subject matter experts (SME) give only a narrow and inferior perspective of what’s truly needed and required for the EHR. Forcing the DOD to comply with the way CERNER works would be best if this is to work. Otherwise, it’s clear that CERNER (and LEIDOS) was the wrong selection. Interesting that the award was given to an IT company instead of an EHR focused IT company like EPIC or ALLSCRIPTS - which were the two other finalists for the DOD EHR award. The DOD will see “bridges,” “patches,” “fixes,” “band-aids,” “interfaces,” that will simply become the 21st century version of the 20th century legacy system it was supposed to replace and improve. The VA should watch closely and proceed cautiously. Their system will be better in every way, shape, and form and it’s not just because the award is to CERNER directly. Subcontracting is never ideal whether it’s for a home project or for an EHR. Why would you hire a general contractor who subcontracts for a new roof instead of hiring a roofing company directly. Maybe it’s just me……..
  4. Anonymous | - Reply
    It's absurd. Leidos is making a fortune for doing nothing that adds value to the deployment. They are just taking their cut. It's like paying Tony Soprano for protection.
  5. Anonymous | - Reply
    Commenting from the front lines...the system continues to be slow to respond even with all the patches. Then when the patches are installed, they don't tell you when or how long it will be down. Patient safety issue? I guess you decide if you want your loved one laying there when the system goes down or kicks you out for some unknown reason. Once you're in, it's not bad. But it's getting there. And training?? Can we say waste of time? And they continue to instruct the same old useless topics.

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