Coast Guard’s epic fail

Will Cerner Corp.'s MHS Genesis provide the safe harbor the Coast Guard needs?

Our nation’s veterans number nearly 22 million. The armed services have about 1.3 million people on active duty. One day they’ll all have the same electronic health record. Only, don’t hold your breath.

The intended product would be the Cerner Corp.’s  MHS Genesis. It’s operating at one military base so far, sort of on a beta basis. Work is barely underway at VA. Now the Coast Guard, fresh off a $60 million fail, says it plans to climb aboard.

At a hearing earlier this week, USCG officials had to explain why they still owe contractors another $5 million. They scrapped a project with Epic Systems for its EHR two years ago. The Coast Guard has nothing to show for it. In fact, their medical personnel have regressed to paper records.

Where can I donate a package of no. 2 yellow pencils?

At the hearing, it all came out. The Epic project was classic. Scope creep, change orders, poor project oversight and governance. It all added up to costs and schedules that ran out of control. And that testimony came from  Rear Adm. Erica Schwartz, the Coast Guard’s chief medical officer herself. The Government Accountability Office issued a detailed look at this fail.

I’ve watched this over the years at Census, Defense, FAA, FBI, IRS and VA, to name a few. If there’s some magic point at which you stop throwing good money after bad ideas, agencies seem to go a few steps beyond.

Epic Systems says it’s been paid in full. And it defends its work, posting this blow-by-blow back in May. The company says the Coast Guard never asked for money back and gave it “exemplary” ratings.

Having a common EHR seems like a no-brainer. You join the military. Along with your dog tags, you get a health record. You eventually leave and become a veteran. You toss the dog tags into a drawer. The electronic record — a little virtual machine in the cloud — remains on active duty.

Only, we’re talking about software. And nothing connected with software ever goes as planned. Last year, I told VA Secretary David Shulkin that switching from the existing Vista system to Cerner would take 20 years. “You’ll be long forgotten,” I kidded.

Shulkin didn’t debate the point. He merely reiterated the planned conversion time of a few years. But the post-Vista project is already late.

In December, the VA put it on pause because of concerns over interoperability. VA hired one of the research non-profits to review it. Shulkin knows this is his baby, having made the award to Cerner personally. He knows Congress knows it. But VA won’t finish it on Shulkin’s watch. Not even close.

As the bewigged Billy Congreve might’ve said, “Award in haste, enlist Mitre at leisure.”

Now it’s the Coast Guard’s turn to figure it out. At least the VA has Vista in the meantime. The Coast Guard’s paper records put it in a less sustainable situation.

Electronic health records cause headaches for ordinary medical practices. At a breakfast the other day, I was seated next to the managing partner of a large local gastroenterology practice. It takes a lot of support people to enable and give physicians time to actually see patients, he said. That’s why small practices consolidate into big ones.

“I’ve got a whole IT staff just to deal with the @#^^%&*!! electronic health records,” he added.

How much more so for a system serving millions and millions.

Cerner’s motto is, “Health care as it should be.”

Indeed. A very large piece of the federal government’s obligation is leaning on Cerner’s with hope, trust, and contract dollars. Not just Cerner. That company is partnered with Leidos on the DOD project.

Let’s hope this stick holds up.

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