For DoD’s new electronic health records, success comes in small steps

The Defense Department is balancing urgency and patience in deploying its new electronic health record system.

The JEDI contract for cloud computing has generated the most noise lately. The contract, awarded to Microsoft and imprecisely labeled as “massive” or “huge,” will simply add to a growing list of cloud options available to Defense Department agencies. I’d characterize JEDI as non-trivial, but not critical to the success of the enterprise.

A far more transformative contract is slowly working its way throughout the DoD medical establishment. The Defense Healthcare Management Systems office has been iteratively rolling out MHS Genesis, its project for a new electronic health care record, or EHR. It started at a few locations in the Pacific Northwest. Four locations at Travis Air Force Base in Idaho got the system last month in an effort called Wave Travis.

For health care organizations, the EHR is integral to operations. It impacts the safety of patients and delivery of care, of course, but also efficiency of the supply chain, scheduling of staff, and the ability to do trend analysis. MHS Genesis is nearly analogous to replacing the veins and arteries of a patient.

In my interview with the program executive, Bill Tinston, and the services champion, Air Force Maj. Gen. Lee Payne, I got the sense the program balances between getting it right but not taking forever. The two say the records, an iteration of a widely used product from Cerner Corporation, will match the EHR the Veterans Affairs Department is also working to get established. Tinston says that eventually, the same record that mates with incoming service members will stay with them until they reach veteran status. That’s what people mean when they say person-or-client-centered IT services.

In bending a commercial product to federal use, Tinston and Payne emphasized there is no programming. Payne, a physician who has worked with medical records for a career, says instead the Cerner program is highly configurable, and in its commercial state it can accommodate unique Defense medical needs. Still, it’s not an out-of-box product you install and run in a few clicks. In fact, the prime contractor is not Cerner but Leidos, with Cerner as the sub.

MHS Genesis may not be a classic systems integration job, but it has integrative elements. In particular, the need to bring in data from legacy systems to preserve continuity as the old EHR is switched off. They two departments aren’t exactly importing the data wholesale into the Cerner EHR. As Tinston explained it, there’s a “joint longitudinal viewer” that lets clinicians see into the legacy systems for information they need.

“The exact migration plan is something we’re still working,” Tinston said, in an answer to my question about eventually shutting down the legacy system.

I’m also encouraged by the training approach. Tinston and Payne described a training-by-peer process in which initial users help new users with the intricacies. The program office is incorporating learning from the first rollouts. Who hasn’t found themselves in situations where a medical practitioner seems to spend too much time fiddling with ungainly software while you, the patient, sits uncomfortably perched on a roll of butcher paper? Who better to show peers how a thing really works than the early adopters?

None of these projects ever goes as fast or cheaply as promised. But DoD can’t get this wrong. Notably, the Coast Guard has joined Defense and Veterans Affairs in deploying Cerner. When the Coast Guard blew an earlier EHR effort, its health care system reverted to paper files.

Iterative versions, user feedback, minimal custom programming, and patience. Those elements will be essential in this most crucial project.

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