Initial Tests Find Defense Department’s MHS Genesis ‘Not Operationally Suitable’

The rollout of the Defense Department’s next-generation electronic health records system is not going smoothly.

Field tests of the Defense Department’s electronic health system at three locations went so poorly the testing agency scrapped plans to test at a fourth facility, according to a report released Friday.

Those three tests were enough to determine that “MHS GENESIS is neither operationally effective nor operationally suitable,” wrote Robert Behler, the department’s director of operational test and evaluation, in a letter dated April 30. In the letter, Behler recommended the department delay rolling the system out at other locations until his agency is able to complete its testing and the program manager fixes all the deficiencies they’ve found.

“While we still have challenges to come, we are clearly making significant progress. We continue to be and have been open and transparent,” Stacy Cummings, program executive officer for Defense Healthcare Management Systems told reporters Friday.

MHS Genesis is being developed by Cerner Corp. and systems integrator Leidos, which captured a $4.3 billion contract to build the next-generation health records system in 2015. Rollout of the system, which is eventually supposed to serve 9.6 million beneficiaries, was halted temporarily in February after it generated some 14,000 help tickets. Those issues are among several that have not been alleviated, according to Defense officials.

The initial test report found the system doesn’t demonstrate “enough workable functionality,” with users only able to perform 56 percent of the 197 tasks used as performance measures.

The list of flaws is long, including:

• Poorly defined user workflows.
• Increased time for health care providers to complete tasks, in some cases leading them to work overtime or see fewer patients per day.
• Inadequate training.
• Inadequate help desk support.
• Inaccurate patient medical data.
• Excessive system latency.
• System outages.

The latency issues and outages indicate the end-to-end system and supporting network couldn’t support the users at the four tests sites, let alone the hundreds of sites the department eventually plans to add, according to the report.

In a statement issued May 11, the Defense Department's director of test and evaluation acknowledged the project’s complexity and said the PMO “has rapidly incorporated lessons learned from testing” and set up a board with representatives from the military services to improve usability.

“It’s important to get MHS Genesis right,” Defense Health Agency Director Vice Adm. Raquel Bono said. “All of the insight gained during initial deployment has helped us improve MHS Genesis at IOC sites and prepare ourselves for future deployment. I’m fully confident we will build on successes on IOC and address challenges identified.”

JITC plans to complete testing at the fourth site—Madigan Army Medical Center—after a Cerner Millennium upgrade, re-engineering and other systems improvements can be made. Madigan is the largest of the test sites.

In a call with reporters Friday, Cummings stopped short of saying issues highlighted in the report would delay the planned full deployment of MHS Genesis by 2022. Feedback from end users, such as clinicians and health care practitioners, "will be the main voice who is going to tell us if the configuration is ready to move to next site."

"Users are the strongest voice for how we move forward," Cummings said. "So the purpose of this time in the acquisition life cycle is make sure we have the solution in the right baseline and configuration we can take forward to the next sites," Cummings said. 

The issues with MHS Genesis come as the Veterans Affairs Department is determining whether to move forward on a contract with Cerner Corp. to build the same electronic health records system for its 10 million veteran beneficiaries. VA chose to adopt the same health records system as the Defense Department last year under then-Secretary David Shulkin, but his recent ouster and political infighting have left the contract up in the air.  

It’s not just the VA looking to latch on to the program. In April, the Coast Guard announced it would adopt MHS Genesis after years of unsuccessful projects—and millions wasted—trying to build its own system.

Editor's note: This article was updated to correct the amount spent by the Coast Guard.