The U.S. Department of Defense's (DOD's) Cerner electronic health record (EHR) system is now live at four new military sites in the second wave of its MHS Genesis rollout.
The Pentagon announced the EHR system is now operational at David Grant USAF Medical Center at Travis Air Force Base, Naval Health Clinic Lemoore at Naval Air Station Lemoore and U.S. Army Health Clinic Presidio of Monterey, all in California. The health IT system also is now live at 366th Medical Group at Mountain Home Air Force Base in Idaho.
The DOD signed a 10-year, $4.3 billion contract in 2015 with Leidos, Cerner and Accenture to build a new EHR to replace its Armed Forces Health Longitudinal Technology Application system.
The site at Travis Air Force Base is the largest in this second wave and the Air Force Medical Service's flagship medical treatment facility in the U.S., providing care to130,000 military service members and their families.
“It’s important when implementing a solution of this magnitude to remain focused on the customer; our clinicians and patients. It’s really not about IT. It’s about the patient,” Bill Tinston, head of the Program Executive Office, Defense Healthcare Management Systems (PEO DHMS), said in a statement.
The PEO DHMS is the organization tasked with acquiring and deploying the commercial-off-the-shelf, single system EHR across the DOD.
Once fully deployed, the Cerner platform will provide a standardized EHR to more than 9.5 million DOD beneficiaries while providing an advanced platform for approximately 205,000 MHS staff globally, DOD officials said.
The EHR system enables the application of standardized workflows, integrated healthcare delivery and data standards for the improved and secure electronic exchange of medical and dental patient data across the continuum of care, from point of injury to the military treatment facility. DOD officials also said the new system will increase efficiencies and improve patient safety.
The Department of Veterans Affairs (VA) signed a $10 billion deal with Cerner last May to move from the VA’s customized Vista platform to an off-the-shelf EHR to align the country’s largest health system with the DOD.
"When fully deployed, information between the two health care systems will be passed securely, conveniently and easily, helping to ensure a warm handoff of service members into the VA system of care," a DOD press release said.
MHS Genesis also enables patients to access their medical records remotely through the system's patient portal. The system will drive better integration and standardization of care, with patients experiencing consistent and high-quality healthcare regardless of location, DOD said.
DOD officials also said new releases and/or significant upgrades can be expected at least twice a year with smaller configuration changes made more frequently. Depending on the scope and content of the release, these events can be considered minor “go-lives" and will require some level of build, testing, training and operational readiness activities, the department said.
This second wave of rollouts follows an initial launch at sites in the Pacific Northwest that was rife with problems. A scathing report from DOD released in April 2018 said its MHS Genesis EHR is “neither operationally effective nor operationally suitable,” highlighting concerns that the system’s failures jeopardize patient safety.
A Politico article last year detailed major failures in the Pentagon's Cerner EHR implementation. Military and VA health IT specialists and doctors reported that technical glitches and poor training caused dangerous errors and reduced the number of patients who could be treated, according to that article.
Following rigorous testing, training and change management efforts during the initial rollout in the Pacific Northwest, MHS leaders cite changes in training as key to addressing many of the system’s initial challenges.
“Those initial sites gave us critical feedback that informed significant improvements and upgrades in training, workflows, and overall change management strategy,” Air Force Maj. Gen. Lee Payne, the Defense Health Agency’s assistant director for combat support and the MHS Genesis functional champion, said in a statement. “We’ve improved our computer-based and our instructor-led training, with very positive feedback.”
Payne said the implementation of a peer-to-peer support strategy has paid off as well. “We are also using a KLAS recommended ‘peer expert’ model where individuals are trained by experts whose job functions are similar,” he said. For example, an emergency physician will train other emergency physicians; and front desk clerks will teach other front desk clerks, which capitalizes on peer-to-peer support.
Federal lawmakers voiced concerns that the lack of an oversight structure and governance between the VA and DOD will derail progress on the EHR projects.
DOD officials said subsequent waves for the EHR deployment will kick off approximately every three months starting in spring 2020. Full deployment across all military hospitals and clinics is expected by the end of 2023. The next three waves involve additional facilities in California, Nevada and Alaska.