The Defense Department is nearing the finish line in deploying its new, multibillion dollar electronic health record around the world. But the program executive office DoD stood up a decade ago to manage the project isn’t going anywhere anytime soon. After all, as the saying goes, software is never done.
MHS Genesis, DoD’s Cerner-based EHR, is now live at 75% of DoD’s clinics and hospitals, with 160,000 users and 6.1 million beneficiaries in the system so far. The department is on track to finish the project, including the addition of its overseas military treatment facilities (MTFs), by next March, according to DoD’s 2024 budget submission.
“As we’ve gone through this transition, we’re not just replacing a legacy system; it brings new capabilities to bear,” Holly Joers, the program executive officer for Defense Healthcare Management Systems told Federal News Network in a wide-ranging conversation about DoD’s progress toward implementing Genesis. “We’re really excited about creating a lifetime record under the single common federal EHR, and that will enable patient-centered care. It will be a record about the patient, not where care is delivered — from when someone accesses into the military, all the way through service with Veterans Affairs. We’ll be able to gain new insights about population health, the medical readiness of the force, and really ensuring that we’re taking care of our service members and their families.”
The road was extremely rocky at first, as tends to be the case with gargantuan IT projects. After DoD deployed Genesis to its firstsites in the Pacific Northwest in 2017, the department’s director of operational test and evaluation (DOT&E) deemed the project “neither operationally effective nor operationally suitable.” VA is seeing some of the same challenges as it stands up its own new EHR, also based on Cerner’s commercial offering.
Joers said DoD’s experience has been that the deployment process works much, much better once it’s moved beyond the first few sites. After that, a lot of lessons have been learned, and the institution can start to converge around change management and IT deployment practices that make sense for the whole enterprise.
“I can’t comment specifically on VA, but when I look at where they are now, I’m taken back to where DoD was in the 2017-2018 timeframe,” she said. “There were challenges with the network, and so we made rules about what infrastructure had to be in place before a go-live, and how long it needed to be stable before we went live. We looked at our governance and management process to hear different inputs. When you’re only dealing with four sites, everyone wants to make it work for what their workflow was before. So you really have to have the fortitude to look at making an enterprise standard, knowing that it might not match what they’re currently doing today. And we had to go through those growing pains.”
The final mile of DoD’s EHR implementation journey mostly involves its overseas facilities. The department has always planned to save those MTFs for the end of the process — not necessarily because the on-the-ground work is all that different, but because the logistics involving things like network connectivity back to the data centers that house Genesis data are more complex.
“We also have to look at their integration with operational units. Those things that are normal operations in terms of serving the population at a particular base, versus support of operational units that are out there,” Joers said. “And that just creates a dynamic between the teams to make sure that we are dotting the I’s and crossing the T’s to protect information from an operational perspective and a cyber perspective.”
But in some ways, the most interesting parts about what DoD is going to be able to do with MHS Genesis don’t have all that much do to with replacing aging IT systems with another one that’s more modern.
“Software doesn’t really enter sustainment. We use that word, but it’s really operations. And at the end of the day, it’s about how we’re using the data and keeping the system from accruing technical debt,” she said. “The PEO is here to provide digital solutions for patient-centered care. I’m in service to the Defense Health Agency, the combatant commands, the Joint Staff, and our team exists to be able to provide those modern solutions. And I don’t imagine the requirements will die down as healthcare continues to evolve.”
And as an example of how the new EHR’s benefits aren’t entirely limited to having a shiny new EHR, the PEO has started to work on ways to integrate anonymized data from Genesis with other “secondary” data sources – including, for instance, Census data – to make it easier to answer bigger public health questions that might be asked in the future, either inside or outside the military’s health system.
For example: it would be extremely useful to know, on a near real-time basis, what a local community’s total hospital bed capacity and staffing levels are, and how the military’s health system could help — or vice versa — in the event of a local emergency.
“How do we look at whether we need to have a mass casualty center when there’s a crisis, and what would that look like? What is the capacity in the surrounding environment? In terms of the private sector, if we were needed to offload care, all of that information is so critical,” she said. “It’s things like registries, and being able to incorporate things like the longitudinal exposure record that is being worked on in support of the PACT Act. How do we bring that into the clinical space and keep track of population health? We need to keep working on things like health surveillance and biosurveillance.”
And when it comes to those OCONUS sites that are last in line to implement Genesis, Joers thinks data is also key to the overall project.
In the past, she said, the military’s approach to IT in the operational medicine space has been tightly focused on creating applications that can deliver particular types of information for very narrow purposes.
“We’re just flipping that on its head to a data-centric paradigm,” she said. “When we talk to our folks who need this capability, we need to talk about what data they need to view. What do they need to capture? What do they need to transmit in order to make decisions? That could be at the point of injury, like a care decision: How are they going to keep this person alive until they can get them to a larger medical facility? Or things like situational awareness, command and control, and how they’re tracking patient movement. How are we looking at blood supply and bed capacity in a theater? How do we connect all of that information so that folks out in the combatant commands have an accurate sight picture of what they’re dealing with? Those are the kinds of things that get me excited.”