DOD's new health record system isn't suitable for use

MHS Genesis, the $4.3 billion commercial electronic health record system being adopted by the Department of Defense to support the care of approximately 9.5 million active duty service members, dependents and retirees, isn't "operationally suitable" according to a scathing internal Pentagon report.

The April 30 Operational Test and Evaluation report found that users at three military healthcare facilities in the Pacific Northwest where the system was initially fielded in advance of a scheduled departmentwide rollout had problems logging into the system, remaining logged in and getting help desk tickets answered.

Users reported that "essential capabilities were not working properly or were missing altogether," according to the report. These include referrals not processing, incorrect insurance eligibility data, lab results not showing up in the system and more. According to the report, clinicians and other users were already coming up with their own "lengthy and undocumented workarounds" to accomplish routine tasks. The report also documented multiple system outages ranging from two to eight hours during the period of oversight.

The report recommends that the undersecretary of defense for acquisition and sustainment delay further rollouts, improve training and focus on fixing the highest priority defects that could present serious risks to patients. According to the report, 53 system failures qualified as critical, meaning that they prevented "the accomplishment of an essential capability" and such incidents "may also jeopardize patient safety."

The report on the inadequacies of the MHS Genesis system comes at an awkward time for government and for contractors. MHS Genesis is based on the Cerner electronic health record system. Contractor Leidos is acting as integrator on the project. The Department of Veterans Affairs is poised to sign a $10 billion contract with Cerner to replace its existing, homegrown Vista health record system. A final decision on that move is expected by May 28.

Stacy Cummings, the head of the program office running the MHS acquisition and implementation, told reporters on a May 11 press call that the report was based on evaluations conducted in 2017, and that bugs, defects and workflow issues were largely in keeping with what was being reported by users.

"I can't think of a thing that surprised us because we were so lockstep in communicating with the [initial operating capability] sites throughout the IOC time period," Cummings said. "One of the things we learned is that we need to do a better job of preparing our sites from a technology as well as a workflow readiness perspective."

Cerner Senior Vice president Travis Dalton who spoke on the press call said that the implementation problems at the three IOC sites are "consistent with what we might see in a commercial environment."

The help desk issue is still vexing officials. Cummings was grilled on the topic by Sen. Patty Murray (D-Wash.) at an April 26 appropriations hearing. The system was taxed to the point where there were more than 14,000 trouble tickets awaiting attention. At the hearing, Cummings said that the number of unaddressed tickets had dropped to about 6,000, with about 2,000 requiring concerted attention. She noted that a decision to restart the program likely wouldn't come until the end of calendar year 2018.

"My understanding is a lot of these were identified long before deployment," Murray said. "They should have been addressed prior to people all of a sudden using them when people's lives are at stake. So we're following this very closely. And I just don't want everybody to think this is happy-dappy rosy, 'cause there's a lot of issues that need to be addressed and we need to stay on top of this."

On the press call, Col. Thomas Cantilina, the chief health informatics officer, said that help desk personnel were "overwhelmed' by the flow of tickets, because of poor program design.

Col. Mike Place, the commanding officer at Madigan Army Medical Center, one of the IOC sites, told reporters that users may have seen it as their job to jam the system with any issues they found. "We take a certain … perverse pride in finding all of the different things we think we can do better," he said.

According to Cummings and other officials on the call, none of the fixes required by the report is likely to extend the current deployment timeline. The plan is to deploy the system DODwide beginning in 2019 and ending in 2022. Cummings told lawmakers last month that the decision to deploy "requires … baseline software configuration and a repeatable agile deployment strategy to support program deployments beyond the Pacific Northwest."