New EHR live at more DoD facilities, Coast Guard pilot sites after initial pandemic delay

The pandemic forced the Defense Department and the Coast Guard to temporarily pause deployment to more sites this summer, but DoD officials say they’re back on track and on schedule with implementation of the new electronic health record.

A total of 18 DoD sites are now using Cerner’s Millennium platform, known as MHS Genesis, Pentagon officials said Tuesday at the vendor’s virtual health conference.

As of March, DoD had deployed the Cerner platform to eight military treatment facilities. It was scheduled to deploy the electronic health record to a third group of facilities, known as “Wave Nellis,” in June.

But the pandemic forced DoD to pause deployment and implementation in March.

Those facilities, which included Nellis Air Force Base in Las Vegas, eventually went live on Sept. 26, Craig Schaefer, the program manager for DoD’s Healthcare Management System Modernization Program Management Office, said Tuesday during Cerner’s virtual conference.

“While we took that tactical pause with our engagement with the sites we were deploying with, we were working on [improving] our deployment processes,” he said. “We knew when we got the green light to go back to the sites we weren’t starting over or getting the momentum completely back. At the same time there was no interruption in our improvement of our capabilities.”

During the “tactical pause,” DoD officials revisited training procedures and infrastructure needs at the upcoming sites under “Wave Nellis.” It also prepared for its third upgrade, which included new Millennium code, as well additional capabilities such as voice dictation and referral management, which DoD deployed this summer.

DoD also revisited its upcoming deployment schedule. A fourth deployment wave is coming at the end of the year, with three other deployments coming in the first, second and third quarters of 2021, Schaefer said.

Having the new electronic health record during the COVID-19 health crisis has proved to be beneficial for those military treatment facilities that are using MHS Genesis, Col. Thomas Cantilina, chief health informatics officer for the military health system, said Tuesday.

Eight military treatment facilities have started using the Cerner platform to track bed and ventilator availability, as well as COVID-19 testing capacity, during the pandemic.

Those facilities also used the Cerner platform to field COVID-19 questions from their patients. MHS facilities reviewed and answered those questions, using the Cerner platform to communicate with patients and direct them to a phone or video telehealth visit with their doctor or a clinic for in-person treatment or testing. Providers at these facilities received common treatment updates as guidance from the Centers for Disease Control and Prevention changed, Cantilina said.

Coast Guard now live with new EHR

The Coast Guard achieved a milestone of its own when it went live with the EHR at four pilot sites in California in late August.

Like DoD, the Coast Guard also paused EHR deployment activities during the height of the pandemic earlier this spring. It established a new working group to determine how and when it could resume those activities, said Willie Davis, the program manager for the Coast Guard’s Electronic Health Records Acquisition Program.

Before the pandemic, the Coast Guard was planning to train new EHR users at its four pilot sites in person. But the working group found a way to train those users virtually, Davis said.

“We really had a take a close look at the plan for training and trying to do that in person,” he said. “The working group had to assess between trying to do it in person given the COVID-19 environment, having the end user in the room with the instructor with a mask and googles on and trying to use the new system… while maintaining social distancing safeguards during the training, which is a couple hours. On the other hand, we could have them at a computer and able to speak and hear freely with masks and googles on and utilize some of this new technology.”

The Coast Guard used DoD’s version of Microsoft Teams for some pieces of the electronic health record training, which David said the end-users embraced.

“We are new to it; we just joined the DoD on using that tool,” he said. “But it went really well, primarily based upon feedback from the end-users. They felt prepared.”

The Coast Guard is evaluating whether it will use virtual EHR training for its remaining deployments, Davis said.

The recent EHR deployment is certainly a milestone for the Coast Guard, whose patients and providers have been using mostly paper health records after its own attempt at adopting a modern EHR failed back in 2015.

The Coast Guard in 2018 agreed to join DoD and the Department of Veterans Affairs in deploying a new, multibillion-dollar electronic health record based on the Cerner Millennium platform.

VA, meanwhile, is scheduled to go live with an initial set of capabilities at its first site, the Mann-Grandstaff VA Medical Center in Spokane, Washington, on Oct. 24. VA twice postponed EHR implementation in Spokane, with development and training delays and then the pandemic delaying the department’s plans.

Schaefer said the pandemic bought DoD and VA more time to coordinate their own deployment efforts and improve the system capabilities they planned to eventually deploy.

In an effort to further integrate and share their capabilities, DoD will also begin using VA’s Video Connect platform for telehealth visits within the military health system later this fall, Cantilina said.

“We decided to pursue and adopt that platform and integrate it into our workflows,” he said of VA’s video platform. “Starting this fall not only will our legacy facilities be able to leverage that platform independent of their EHR… we’ll be able to start to integrate it right into the workflow with MHS Genesis.”

VA Video Connect, which is responsible for a more than 1000% increase in telehealth appointments since March, will be integrated into military providers’ desktops and the HealtheLife Cerner portal for patients.

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