The Coast Guard said Monday it would join the departments of Defense and Veterans Affairs in deploying a new, multibillion-dollar electronic health record based on commercial-off-the-shelf software.

The step will eventually let the service move away from the paper-based treatment records its clinics resorted to, amid a failed previous attempt to adopt a modern EHR. But precisely when that will happen remains unclear.

Indeed, apart from the decision to adopt the system, known as MHS Genesis, almost every aspect of how the Coast Guard will implement it remains unanswered. Questions include how much it will cost, where the initial fielding sites will be, and how the service will effectively transition the massive quantity of paper records its clinics have been accumulating into the new electronic system.

Despite those uncertainties, the Coast Guard said a rigorous analysis of alternatives, led by its own acquisition officials, had determined that adopting the DoD system was the best course of action. Thousands of its members are already treated in DoD facilities, and like members of the other branches, its personnel will eventually be served by the VA.

“Our assessment is that our requirements are nearly 100 percent the same as DoD’s,” Rear Adm. Michael Johnston, the Coast Guard’s director of acquisition programs, told reporters Monday. “We’ll pay for the services that we get, and we’ll partner with DoD to clarify how that best works in their strategy.”

Aligning health IT with other military

Unlike VA, which has said it will enter into a contract directly with Cerner, the maker of the software suite on which Genesis is based, the Coast Guard’s rollout will be incorporated into the $4.3 billion contract DoD has already signed with Leidos, the lead systems integrator for the new EHR.

Defense officials said they do not yet know if the overall contract ceiling will need to be raised in order to accommodate the Coast Guard’s needs, which are tiny in comparison with the four other armed services. It operates only about 30 mostly-small clinics, compared with the 56 hospitals and 361 outpatient clinics run by the Army, the Navy Department and the Air Force.

Nonetheless, Stacey Cummings, the lead acquisition official for Genesis, said the Coast Guard’s decision to join the program meant that its health IT needs would be considered in the same way as those of the other military services.

“As we’re going through the process, if we find that there are areas where the Coast Guard has a better way of doing things or if there is uniqueness that needs to be addressed in Coast Guard facilities, we’ll consider them just as we would any of our customers,” said Cummings, who is the program executive officer for Defense healthcare management systems. “We have the processes in place to look at those from a governance perspective so that everyone benefits from that standard workflow that we can then push across our entire enterprise. That’s important, because we all have users that move frequently from site-to-site more frequently than you might see in a commercial environment.”

However, a notice DoD published on Monday indicates that its new partnership with the Coast Guard – in combination with VA’s decision to adopt the underlying Cerner product – will require more work than was originally anticipated in its contract with Leidos.

In the filing, Defense officials said they planned a sole-source modification to its original agreement with the Leidos Health Partnership to incorporate the VA and Coast Guard’s needs into the system.

“Some of the extended capabilities necessary to maintain a single standard solution baseline with the VA and USCG are provided as clinical application services (CAS) not covered by the existing DHMSM license agreement,” officials wrote. “These CAS capabilities cannot be fully realized unless they are implemented in the Cerner environment. In order to fully enable these functionalities, MHS Genesis requires direct access to proprietary Cerner data, which is only available from Cerner. Utilizing any other solution would prevent access to these capabilities and render it impossible to maintain a single standard baseline solution with the VA and USCG.”

Officials invited other vendors to submit proposals for the extra work the VA and Coast Guard’s integration into the system will require, but stipulated that those companies must have legal agreements in place with Cerner to access its intellectual property. DoD reserved the right to ignore proposals that did not meet that test.

Johnston declined to say how much funding the Coast Guard expects to contribute toward the project, saying contractual arrangements need to be finalized before those estimates are publicly disclosed.

Overcoming failed past project

The service sent strong signals that it intended to adopt Genesis during a Congressional hearing in January, amid grilling from lawmakers about a now-aborted project under which it would have procured its own health record from another commercial provider, Epic systems.

The Coast Guard spent seven years and more than $60 million on that project — Integrated Health Information Systems — which it never deployed. The failure of IHiS was due in large part to creeping requirements that went well beyond what Epic’s commercial EHR was intended for, officials said at the time.

The Coast Guard formally canceled IHiS in 2015, but had already made the decision to decommission the legacy electronic systems it was meant to replace. Since then, its clinicians have been recording almost all of their patient data on paper forms.

Johnston said his service had learned lessons from the mistake, including that software projects of this size and complexity need to be managed as formal acquisition programs, a decision the Coast Guard made in Feb. 2016.

“That was done separately by another directorate,” he said. “We said, ‘Hey, we need to stop that thing and start it as an acquisition program with the rigor and the governance to make it happen right,’ and that’s what we’ve been doing.”

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