New schedule for military EHR rollout is imminent

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.