DOD unhappy with electronic records upgrade

After spending $2B on efforts, DOD now wants a new system

After spending $2 billion to upgrade its legacy electronic health record system, the Defense Department is preparing to conclude that the effort was only partially successful, according to a new report from the Government Accountability Office. DOD wants a new system, GAO said.

In 1997, DOD began upgrading and adding capabilities to its legacy record system in a project named the Armed Forces Health Longitudinal Technology Application (AHLTA). The system keeps track of records for more than 9 million service members and their family members.

Meanwhile, DOD runs risks in buying a new system without learning the lessons from the first system upgrade, the report warns.

“DOD has initiated efforts to bring its processes into alignment with industry best practices,” the GAO report said. “However, it has not carried out a planned independent evaluation to ensure it has made these improvements. Until it ensures that these weaknesses are addressed, DOD risks undermining the success of further efforts to acquire [EHR] capabilities.”


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However, the anticipated new capabilities in AHLTA have been scaled back, including inpatient care management records, and users of the system continue to have problems with low speed, poor usability and unavailability of portions of the system, GAO said.

The department has made plans to improve and stabilize AHTLA through 2015 while it acquires the new EHR system named Way Ahead, GAO said.

The new system is expected to deal with performance problems, provide comprehensive medical documentation, capture and share medical data electronically in DOD, and improve existing information sharing with the Veterans Affairs Department.

As of September 2010, DOD had set up a planning office for Way Ahead and has begun to analyze alternatives for meeting the system requirements. The analysis is due in December.

DOD anticipates choosing a technology solution and setting a schedule for acquisition, with $302 million requested in the fiscal 2011 for Way Ahead.

GAO urged DOD to fix the weaknesses in its management and planning that contributed to AHLTA having fewer capabilities than expected and having experienced persistent performance problems and failing to fully meet users' needs.

Problems with AHLTA included lack of a comprehensive project management plan or tailored systems engineering plan, its requirements were incomplete, and there was no effective plan to improve users’ satisfaction, the report said.

The GAO recommended that the Military Health System CIO:

  • Develop and maintain a comprehensive project plan that includes scope, cost, schedule, and risks and update it regularly.
  • Develop a systems engineering plan.
  • Develop and document a plan for improving user satisfaction.

·DOD officials agreed with the recommendations.

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Reader comments

Thu, Oct 7, 2010 Paul

I agree with Phil that VistA is certainly not a good replacement system. I've sat in on some of the system requirement meetings for Way Ahead and think the idea is sound. I've just been in DoD too long to think the ideals will match the end product. Still, anything is better than AHLTA. It was a band-aid on an outdated system. I just hope VA will engage with us on this and maybe (cross your fingers) we can design the system to accomadate both agencies. More importantly, this system is, and needs to continue to be being, designed with input from all the stakeholders rather than just providers and bean counters.

Thu, Oct 7, 2010 John Weiler Alexandria VA

This GAO Report was right on target, but overlooked the fact that OSD HA had already established a services oriented, best practices Acquisition Framework based on the highly regarded Acquisition Assurance Method (AAM), an emerging consensus based standard. The unspoken challenge with EHR are the many rice bowls and commercial interests that are vested in the status quo. Billions in waste feeds many mouths and many lobbyist. If DOD and VA are going to succeed with EHR, they will need a common acquisition framework that is based on best practices and not MilSpec methods that are protected by Defense Industrial Complex and their FFRDC partners.

Thu, Oct 7, 2010

the DoD is a mess and has only gotten 10x worse since 2001. during the latter part of the 90's, DoD was supposed to implement some really strict accounting and auditing practices. the DoD was supposed to implement IT to enable it to account for all the money it received from taxpayers and be able to account for how it was spent -- and be able to provide a good audit trail to prevent waste, fraud, and abuse. you don't hear anything about that anymore, and i am sure the DoD accounting system and practices have not gotten any better. where's the beef?

Wed, Oct 6, 2010 Phil

Vista has it's own issues and I bet it is not capable of addressing alot of issues that occur on the DoD side. How many babies are born in the VA hospital vs how many are born in military facilities? There are issues that the VA have not had to deal with. Colaberative efforts need to be put in place before one system can satisfy either community. Don't kid yourself that the VA system is the end all be all of health care electronic records.

Wed, Oct 6, 2010 Bill

This is a disgrace. They could have used the highly successful VA VistA system essentially for free decades ago but no way. DoD insisted on spending a bajillion dollars on a system (systems actually: CHCS, CHCS-II and AHLTA) that never ran half as well as VistA and were never fully deployed. Even after this debacle I'll bet they won't consider using VistA but will waste millions more on another half-way system.

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