Initial report shows Pentagon EHR rollout still has big problems

A team of independent Pentagon investigators gave another poor grade to the MHS Genesis electronic health record implementation in the Pacific Northwest, according to sources familiar with an executive briefing on the report.

The Initial Operational Test and Evaluation at Madigan Army Medical Center, just outside Lakewood, Wash., found MHS Genesis remains “not effective and not suitable” — conclusions similar to those reached in an April report on three other sites, in Spokane and the Puget Sound. The latest report also said MHS Genesis was “not interoperable,” according to two individuals who saw a summary briefing provided to Stacy Cummings, the DoD official in charge of the project.

Despite the negative assessment, the surgeons-general of the four military branches have signed off on moving forward with MHS Genesis, which is running at the four Northwest sites and is planned to go live at three additional bases in California and one in Idaho next year, the two sources said.

A Pentagon official said that while Cummings has been briefed on the findings, the final report was not finished. “I expect the report to recognize significant system improvement” in response to problems that were broadcast in the April report, said David Norley, Cummings’ executive assistant.

Officials planning the next stage of the implementation are increasing training of clinicians and will have more Cerner experts on site to assist with problems. Already, officials running the implementation have reduced the average time required to respond to complaints from 84 days to fewer than six, Norley said.

But one Pacific Northwest doctor, speaking on condition of anonymity, said the fixes still required too much time. Military clinicians who attended Cerner’s annual conference in Kansas City earlier this month were impressed by the company’s capabilities, the doctor said, “but we’re lagging way behind where we should be because our processes aren’t agile enough. We’ll get there, but it’s going to take time and money.”

It isn’t clear how much the military intends to change MHS Genesis in response to complaints about usability and other issues, but Norley said the current version will be improved. In any case, he said, “the baseline solution allows more data sharing, greater patient safety features, and more cyber security protection than the legacy system it replaces.”

A Cerner spokesperson declined to comment on the report.

VA and Defense secretaries on Sept. 26 signed an agreement pledging to “align their plans, strategies and structures as they roll out a EHR system that will allow VA and DoD to share patient data seamlessly” for 18 million people covered by the two systems. They also promised to create a new organizational structure that will put the power to resolve differences in a single office.

It’s not clear how much the systems will be allowed to diverge. More similarity could mean easier transmission of patient data between DoD and VA facilities. Yet the two services meet drastically different needs for active-duty troops and veterans.

To this point, the chief of the House Veterans’ Affairs subcommittee overseeing the EHR deal complained in an Oct. 10 letter to acting VA Deputy Secretary James Byrne that the VA appeared to have abandoned its Lighthouse project, an in-house project to create an open API platform into the VA’s health system.

Rep. Jim Banks (R-Ind.) wrote that it was important for the VA to “future-proof” its Cerner acquisition with the technology so it can import software and apps that may go beyond what Cerner can provide.

VA spokesman Curt Cashour said the agency would respond to Banks’ request for information about whether the agency was still committed to the open API pledge.

VA recently issued a list comparing the Cerner modules in its contract with those in MHS Genesis.

Notably, the VA has enhanced specialty services like radiology, labs and cardiology, more interoperability functions as well as prescription drug monitoring, population health and administrative software, largely absent from MHS Genesis.

The VA contract with Cerner and its partners is approximately $10 billion, while the DoD contract currently is $4.3 billion.

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