New schedule for military EHR rollout is imminent

After missing a congressionally mandated deadline, the Defense Department is prepping a new schedule for the rollout of its electronic health record.

 Shutterstock image: global health.
 

The Department of Defense will decide on a new schedule for the rollout of its new, commercial electronic health record product in the next seven to 10 days, according to a spokesperson.

The new health record system, dubbed MHS Genesis, was scheduled to have an initial operating capability in the Pacific Northwest by Dec. 31, 2016, to comport with the date set in the 2013 National Defense Authorization Act.

Part of the reason for the delay is that the Defense Healthcare Management Systems program office set up an "aggressive" schedule to hit the legislative deadline, according to communications director David Norley. He pointed out that the Federal Acquisition Regulation specifies a six-month window when it comes to implementation schedules. By that measure, DHMSM is well within the acquisition milestone.

The reaction so far on Capitol Hill to the delay has been accepting, Norley said, but there are limits to legislators' patience.  "If we don't hit it by the end of May, they're going to have some serious questions for us," he said.

A May 2016 audit of the DoD Healthcare Management System Modernization Program by the Pentagon's inspector general cautioned that the schedule "may not be realistic for meeting the required initial operational capability date of December 2016."

FCW obtained a redacted copy of the full report via a Freedom of Information Act request. The OIG had released only a summary of the report to the public.

The report found that conduct of the acquisition, which resulted in a $4.3 billion award to integrator Leidos, electronic health record company Cerner and other partners, was done by the book.

At the same time, the report cautioned that delays are possible "because of risks and potential delays involved in developing and testing the interfaces needed to interact with legacy systems, ensuring the system is secure against cyber attacks, and ensuring that the fielded system works correctly and that users are properly trained."

This language was suggested by DOD Operational Test and Evaluation Director J. Michael Gilmore in April 29 reply comments. In his letter, he pushed back against the IG's assertion that testing the system alone was creating risks of delays, although he did allow that the schedule was at risk.

Norley echoed Gilmore's remarks about the complexity of the task of launching a system that is designed to integrate with and eventually replace dozens of existing electronic systems. He noted that while DOD has eliminated a "couple of hundred" systems, many remain. The IG report suggests that these number at least 20. (A list of the names of the systems to be retired was redacted from the IG report, but many of them likely are to be found on this list of systems of records maintained by the Defense Health Agency.)

The new system must integrate and share data with the legacy systems during a period of testing and transition that will span several years. The coders at Cerner and Leidos are facing a heaver lift than is the case when a private sector health care system replaces one commercial off-the-shelf system with another.

"They're probably writing more interfaces than they're used to," Norley said.

Another piece of the puzzle is maintaining the connection to Cerner's core product, despite the customization required to link to DOD's legacy systems, and to meet other DOD-specific requirements. Norley noted that high levels of customization is "where government seems to get into trouble," when it comes to large scale software implementations.

"We want to get updates from Cerner as they become available at the same time as any commercial customer," he said.

Cybersecurity is another big lift. MHS Genesis must comply with all the DOD CIO cybersecurity requirements. Unlike a typical commercial customer, DOD has been able to look under the hood of Cerner software to evaluate the security. While the Cerner system already meets commercial standards, getting the DOD seal of approval, "requires additional testing, and solving all the issues that are there," Norley said. "That has taken a little more time."

This is especially critical, Norley said, because "the hacking of medical software and the holding for ransom of medical records has become a huge issue in the health IT arena."

But even more than the technology, Norely said, is the grinding work of standardizing the workflows of Army, Navy and Air Force practitioners. For decades the services had developed their own methods that met their needs, he noted. But the differences big and small between these approaches must be ironed out to accommodate a single commercial system. The implementation effort has included taking "somewhere in the neighborhood of" 700 clinicians and sequestering them in meeting rooms to come up with standard business practices for more than 800 workflows, Norley said.

"Technology is not the biggest factor of an integration of this size and magnitude, it's standardization," he said.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.