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Both departments are fixing problems in early EHR rollouts, but years of work remains

The departments of Defense and Veterans Affairs still have a very long way to go before they achieve the long-sought objective of a fully integrated electronic health record infrastructure. But a pair of recently released oversight reports show that the multibillion dollar EHR programs, both of which had rocky starts, have made meaningful progress in just the past year.

The Department of Veterans Affairs delayed its initial rollout of the Cerner Millenium EHR suite twice last year — once to allow for more training, and then because of COVID-19. But the department managed to complete its first deployment, in Spokane, Washington, in October.

But before that, VA spent the prior four months squashing bugs that could have derailed that deployment. According to a Government Accountability Office report released late last week, tests as of June 2020 showed VA’s Cerner implementation had 530 “high severity” findings and 29 “critical” ones. By the time of the October deployment, it was down to zero critical issues and 55 high severity findings. And VA had found acceptable workarounds for 47 of them.

GAO cautioned that VA is sure to find more problems as it conducts more testing and deploys the EHR to its next site, the larger Puget Sound medical center in Seattle sometime between July and September of this year. But the initial results are encouraging. The watchdog did say, however, that the department should put any more deployments on hold until all those high severity findings are resolved.

Meanwhile, the Pentagon’s office of the Director of Operational Test and Evaluation (DOT&E), which has been harshly critical of DoD’s version of the EHR, also found a few positive things to say in this year’s annual report.

The first round of operational tests on the system, in 2018, found it was neither “operationally effective nor operationally suitable.” As of the latest report, DOT&E deems the system, known as MHS Genesis, operationally effective for basic clinical operations. It’s still not met that threshold for specialty care, but progress is progress. Meanwhile, overall system usability has improved from “unacceptable” to “marginal-low,” according to DOT&E.

And the department has gone some way toward improving Genesis’s cyber posture, which the office previously assessed as “not survivable” in a contested cyber environment. Starting in August, the Defense Health Agency stood up a permanent team to simulate persistent, real-world cyber threats against Genesis to continuously tests the system’s defenses.

“The innovative program will assess the cyber posture of MHS Genesis and the effectiveness of network tools, cyber defense tools, and cyber defender processes, and is one of the best ways to improve the program’s defenses against nation state-level threats,” according to the report.

In September, DoD deployed Genesis to its latest round of 10 hospitals and clinics in California and Nevada, in a part of the phased rollout known as “Wave Nellis.” And to be clear, DOT&E believes the system still has a very long way to go. Overall, testers believe Genesis is still not operationally suitable, partly because of insufficient training and usability problems.

But like VA, DoD does seem to be solving new problems as they appear during the rollout process – even if the pace of those fixes is slower than clinicians and patients might like. Eighty percent of the problems identified during initial testing at the first hospital rollout have been solved, a feat that even DOT&E terms a “significant achievement.” —JS

Marine women have longer to recover from pregnancy before testing

The Marine Corps is expanding the amount of time women have between having a child and taking physical fitness tests. The longer period of time drives straight to the heart of issues surrounding women’s health and the military that have gained saliency in recent years.

Women Marines now have 12 months from the time they give birth to the time they need to take a fitness test, an increase of three months from the previous policy. The Marine Corps is now on par with other military services like the Air Force, which already give post-partum women a year before testing.

The Marine Corps says the new policy will lower the risk of injury and prevent issues with women losing weight too quickly causing limited breastmilk production.

The policy change comes as Defense Department advisors, service members, lawmakers and outside experts are all pushing the military to rethink how it approaches women’s health.

House Armed Services Military Personnel Subcommittee Chairwoman Jackie Speier recently told Federal News Network she was interesting in investigating issues pregnant women in the military are experiencing.

“There are two cases that have just been made public about service members who are 14 or 15 years in, who’ve had babies and have had issues losing the weight in a timely fashion,” she said. “We need to evaluate whether or not that is fair and whether or not that is a form of discrimination.”

It’s not only pregnancy issues that the military is overlooking though.

Last year, the Defense Health Board conducted a year-long study that found the Pentagon is not providing proper medical care to women, and therefore wasting money and hurting readiness.

“Active duty women continue to experience high rates of stress fractures and other musculoskeletal injuries, urogenital infections, unintended pregnancies, sexual violence, anxiety, depression, adjustment disorders, and eating disorders. These conditions adversely affect active duty women’s readiness and health,” the authors concluded.

The board stated that DoD had been consistently made aware of these issues over the last 70 years and did little to rectify the problems.

A lot of difficulties stem from things as simple as making equipment for women. Clothing and armor made for men can be dangerous for women, the lack of proper footwear and the need for better support through sports bras also contribute.

The board gave DoD a handful of recommendations to help make life in the military more manageable for women. — SM

Army crowdsourcing solutions to sexual assault prevention

One of the Army’s airborne corps is taking a different approach to erase sexual assault and harassment from its ranks.

The Army’s XVIII Airborne Corps, which encompasses 92,000 soldiers across 14 installations, is calling on its own members to come up with ideas for bettering sexual assault and harassment prevention and response.

The initiative is part of the corps’ Dragon Lair program — a Shark Tank-like competition that promotes innovative ideas from rank-and-file soldiers.

“Our panel of experts plus the command determines if the idea is appropriate for implementation across the corps,” the corps’ public affairs officer Col. Joe Buccino told Federal News Network. “There’s one soldier/innovator selected as the winner of that Dragon’s Lair. That soldier is awarded, and that idea is implemented.”

Corps Commanding General Lt. Gen. Erik Kurilla decided to prioritize sexual assault as a crowdsourced challenge after hearing from a handful of soldiers around base who had thought deeply about the issue.

“You have tons of ideas that are often locked down at the lowest level that are trapped by this Army hierarchy of grade rank and experience, and just bureaucracy,” said Capt. Annie Blank, aide-de-camp to the corps’ deputy commanding general said. “If we can flip this paradigm where we can empower and give a voice to all those ideas, but with the backing of the rank of someone like Lt. Gen. Kurilla, we might be actually be able to produce something innovative and implement it at like a wide breadth across a corps.”

Soldiers can submit their ideas online until Feb. 16 and a winner will be chosen on Feb. 22.

The challenge comes as newly confirmed Defense Secretary Lloyd Austin ordered a review of military sexual assault prevention programs.

The RAND Corporation put out a study last week explaining the effects sexual assault and harassment had on military retention rates.

The study found that victims were twice as likely to try to leave the military in the 28 months after being assaulted.

“An estimated 2,000 more separations occurred than would be expected had members not been sexually assaulted, and 8,000 separations (or roughly 8% of all separations) were similarly associated with sexual harassment” over the two-year period the study investigated. — SM

Space Force thinking about permeable active and reserve force

The Space Force is may be taking an unorthodox approach to building its components in hopes of making life more flexible for future guardians.

Space Force Staff Director Lt. Gen. Nina Armagno said the service is considering combining the active duty and reserve components to make it easier for service members to move from full time troops to part time.

“The Space Force is looking at more creative ways to partner with the Guard and reserves,” she said. “We’re actually working on a dual component, where instead of having active, Guard and reserve, we have a combined active and reserve force and then, potentially, a separate Space Guard.”

The Space Force and Air Force are working on a proposal for Congress to build a Guard component.

Armagno said the service is “working on trying to figure out how to recruit and retain the best. You recruit talent, but you retain families is another saying it. This would allow some kind of sweet spot combination between active and reserves.”

Guardians would possibly be able to go into the reserves to have a child or pursue a degree.

At this point, the military branch is only considering the idea and nothing is set in stone.

Other military services have considered making their components more flexible, but have run into some bureaucratic issues. The Space Force’s ability to build from the ground up gives it the chance to try new personnel permutations. — SM

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