DOD’s new EHR faces low user satisfaction and integration challenges, watchdog finds

The Department of Defense has deployed its new electronic health record system at all of its military hospitals and clinics around the world but still faces low user satisfaction rates and integration issues with the new software, according to a recent report from the Government Accountability Office. 

DOD awarded a contract in 2015 to Cerner — which was acquired by Oracle in 2022 — Leidos and several other companies to modernize its legacy health system. The Department of Veterans Affairs similarly contracted with Cerner in 2018 to modernize its outdated EHR system and make the new software interoperable with DOD’s EHR. 

The watchdog study, released on April 18, reviewed annual surveys of clinicians’ satisfaction with DOD’s EHR system — known as MHS Genesis — and found that satisfaction rates “increased minimally between 2022 and 2023 but lagged behind satisfaction rates for users of DOD’s legacy systems and users of the same commercial EHR solution as DOD.”

GAO’s report found that users of the new system continued to express concerns with the software’s response time, their ability to work efficiently and their ability “to deliver high quality care” for servicemembers and beneficiaries. Compared to the 2022 survey responses, however, the watchdog did note improvements when it came to clinicians’ ability to deliver more patient-focused care.

“​​Although user satisfaction levels are below those for its other relevant systems, DOD has not yet established satisfaction goals,” GAO said. “Without goals for improving user satisfaction, the department will be limited in its ability to measure progress, plan for improvements and ensure the system meets users' needs.”

DOD’s dental module, known as Dentrix, was also cited as a major concern in the report, with GAO noting that the department has experienced “persistent problems” with the software but “does not yet have a plan or schedule for identifying alternatives.” 

“Until the office resolves the Dentrix issue, the new federal EHR will not provide critical functionality to dentists who treat DOD beneficiaries,” GAO said.

The report also examined DOD and VA’s joint deployment of the Oracle Cerner EHR system at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois in March, which marked DOD’s final rollout of its new software. VA paused rollouts of its EHR system last year to address a myriad of issues with the new software but maintained its deployment at Lovell as part of a larger reset for its modernization project. 

While GAO found that both agencies “completed critical tasks” to successfully deploy the new system at Lovell — including all 35 tasks and milestones included in their implementation plan — it found that “integration opportunities remain.”

The report said areas requiring further integration include patient care locations, the dental systems and the organization of Lovell’s pharmacies. DOD and VA cited “legal and policy barriers” and “a lack of time and resources” as challenges to further integration. 

“Until it addresses these barriers, DOD and VA will likely not meet the integration goal established for the Federal Health Care Center,” the report said. 

GAO made four recommendations, including for DOD and VA to each resolve integration issues at Lovell and for DOD to “establish user satisfaction targets and implement a plan to provide a dental module alternative.” Both agencies agreed with the watchdog’s recommendations.