As the Department of Defense begins to deploy its new Cerner electronic health record system over the next five years, the military is leveraging important lessons learned from the EHR’s initial deployment.
The EHR system—called MHS GENESIS—is on track for full deployment worldwide by the end of 2023. However, the initial rollout of the Cerner Millennium platform to pilot sites has not been without some major challenges.
The system was deemed “neither operationally effective nor operationally suitable,” according to a 2018 report from DoD’s director of operational test and evaluation that was based on an assessment of three of four pilot sites in Washington State.
Nonetheless, DoD officials say the purpose of the 2017 initial deployment of MHS GENESIS to the four pilot sites was to evaluate the system for full-scale deployment, identify additional change management issues, as well as resolve infrastructure and security concerns. They contend that the lessons learned from those sites are what will make the worldwide deployment of MHS GENESIS a success.
“The deployment to these pilot sites allowed DoD to better understand technical, configuration and adoption challenges that are typical in an EHR deployment,” Stacy Cummings, principal deputy assistant secretary of defense in the Office of the Assistant Secretary of Defense for Acquisition, told a Senate subcommittee on Wednesday.
According to Cummings, having a “stable” network infrastructure in place several months prior to EHR installation are among the lessons learned from the pilot sites. She said that deploying the network at the same time as the EHR ended up being “too much change and too much instability for the sites to be able to handle and react to.”
As a result, going forward, Cummings said DoD has established a “six-month buffer” requirement for future deployments of MHS GENESIS so that the “modern” network—which provides the bandwidth needed for fast access to the system—is up and running and considered stable before EHR installation occurs.
In her testimony, Cummings indicated that about 90 percent of “incident reports” gathered at the pilot sites involved workflow and configuration, end user knowledge of the system, policy issues or recommendations for future enhancements.
She also revealed that the remaining 10 percent of the incident reports “can be traced to a defect in the software solution that makes up MHS GENESIS” and that “100 percent of the defect incident reports that the functional community categorized as high priority have been resolved and recommended for closure.”
Cummings noted that the 2018 report from DoD’s director of operational test and evaluation recommended “follow-on operational testing and evaluation at the next fielding to evaluate corrective actions and revised training, to inform future fielding decisions.” It’s a recommendation that she said will be implemented at the next deployment sites.
“Deployment of MHS GENESIS will occur by region—three in the continental U.S. and two overseas—in a total of 23 waves,” testified Cummings. “Each wave will include an average of three hospitals and 15 physical locations and will last approximately one year. Regionally grouped waves, such as the Pacific Northwest, will run concurrently.”
She observed that this approach enables DoD to “take full advantage of lessons learned and experience gained from prior waves to maximize efficiencies in subsequent waves, increasing the potential to reduce the deployment schedule in areas where necessary.”
The next MHS GENESIS deployment wave will include Travis Air Force Base, Naval Health Clinic Lemoore, Presidio of Monterey, Mountain Home Air Force Base, and surrounding clinics.
“Complex business transformation requires constant coordination and communication with stakeholders and partners, including the medical and technical community, to ensure functionality, usability and data security,” Cummings testified. “While there is still much work to do, the integration of the commercial data hosting (by Cerner) into DoD networks and systems represents a new direction in Pentagon IT culture and practice.”
“Change is always hard,” she added. “This is especially true when deploying a single, integrated inpatient and outpatient EHR, while standardizing enterprise wide workflows across more than 400 military treatment facilities.”