Pentagon's EHR Setbacks ‘Don't Bode Well’ for Potential Veterans Affairs Rollout

The Pentagon is facing major setbacks in the rollout of its new electronic health records platform, and that dampens the outlook for the Veterans Affairs Department as it prepares to implement the same system, said the agency’s former leading technologist.

The Defense Department reported Friday the MHS Genesis system it’s spending $4.3 billion to develop “is neither operationally effective nor operationally suitable.” Initial field tests at three facilities were so bad the agency decided to cancel the testing at a fourth location and delay further pilots until it can address the numerous flaws it uncovered.

As the VA finalizes a contract potentially worth $16 billion with Cerner Corp. to put the agency’s 9 million beneficiaries on the same Genesis platform, former chief information officer Roger Baker told Nextgov the agency should prepare to face the same problems—if not more of them.

“It’s no surprise that a program as big as MHS Genesis...is going to have problems like this—according to all the metrics, most large federal IT programs aren’t successful,” said Baker, who held the department’s top tech job from 2009 to 2013. “[VA] need[s] to remember that the probability they’re flushing that $16 billion down the toilet is actually greater than 50 percent.”

But beyond the general challenges inherent in massive IT projects, VA faces an even steeper uphill battle implementing a new system than the Pentagon, Baker said.

For one, most VA doctors don’t mind the current platform. The VA’s electronic health system was rated the best for overall user satisfaction in a survey of more than 15,000 physicians, while the Pentagon’s current platform--the Armed Forces Health Longitudinal Technology Application--scored dead last. “What’s it going to look like when VA is trying to replace the most liked [platform] out there?” Baker said, especially when the military is having trouble convincing doctors to quit one of the least liked.

He also noted that unlike military physicians who are required to follow orders in a rigid command and control hierarchy, VA doctors can push back harder against system changes they don’t agree with.

“You can tell them what you want them to do, but they put patient care far above anything else, and they will tell you where to stick it if they think you’re impacting patient care,” he said.

That environment may not bode well for VA leaders looking to implement a system that during field tests reportedly experienced 156 incidents which could have led to patient deaths, according to Politico.

House Veterans’ Affairs Committee Chairman Phil Roe, R-Tenn., has asked to meet with the agency’s leaders “in light of [the Pentagon report’s] troubling findings,” his communications director Tiffany Haverly told Nextgov.

Baker said VA might be even less equipped to lead a project of this size given the recent shakeups in agency leadership.

Staying focused on the final product and having “the wherewithal to say ‘no’” to anything that doesn’t serve that end is “the most critical” factor in the success of a large scale IT program, he said. And after former Secretary David Shulkin’s ouster, Baker doesn’t see anyone at the VA willing to take that stand.

“In making the decision to go to the new EHR, [Shulkin] demonstrated that he was willing to make very tough decisions whether people liked them or not,” Baker said. “Without that, the probability of success with any large IT program...is almost nil.”

He still finds it highly unlikely the Pentagon’s test results will unravel the Cerner deal, which VA Chief Financial Officer Jon Rychalski told Congress is scheduled to be signed May 28.

“I think VA’s too far down the road at this point,” Baker said.

To mitigate the chances the agency repeats the Pentagon’s failures, he suggested VA pilot Genesis at a single facility and work out the kinks before scaling to a larger rollout.