- The Department of Defense (DoD) is still on schedule with its MHS Genesis EHR system rollout, officials told FCW.
The $4.3-billion Cerner EHR system has received a significant amount of complaints from users related to problems with clinician workflows and other clinical and administrative processes. However, DoD officials revealed the eight-week pause on the project was built into the schedule and project timeline.
According to Defense Healthcare Management Systems Program Executive Officer Stacy Cummings, the schedule called for a period of time to process user feedback before proceeding to the full deployment phase. The full deployment phase is expected to begin in early 2019.
After completing the Initial Operational Capability (IOC) deployment in the Pacific Northwest, EHR system users submitted about 17,000 support requests or trouble tickets. About 11,000 trouble ticket problems have been resolved.
About 5,000 remaining trouble tickets are considered tier 3 problems. Tier 3 problems involve enterprise-level changes that require higher approval from authorities, said a DoD spokesperson. Tier 3 issues will be evaluated by Defense Health Agency officials and may result in changes to workflow, training, or the technology itself.
Cummings said trouble tickets include feedback about basic tech support, policy and procedure changes, and requests about new features.
A significant portion of tier 3 tickets involve problems with clinician workflow. Problems with clinician workflow may be the result of conflicts between plans from officials in charge of the military health system and the day-to-day operations of providers and hospital staff.
Military health officials convened 1,000 perspective users from sites around the world to develop a standard set of procedures and practices, which was embedded into the EHR system to serve as the clinician workflow.
"It was not developed in a vacuum," said Cummings.
Cummings stated consistency within clinician workflows helps offer a common experience for patients, providers, and the health system as a whole. However, the health system’s focus on consistency may also slow progress with workflow changes.
Users that filed a ticket hoping for workflow changes may not get the result they want quickly, she said.
"We empathize with users that put tickets in and hoped to see responses quicker," said Cummings. "We had to wait until we had enough information to make the right decision – and we can see how that would be frustrating."
While the rollout has received a significant amount of complaints, certain sites have also garnered industry praise. The MHS Genesis implementation at Fairchild Air Force Base achieved a Stage 6 HIMSS rating on its Electronic Medical Record Adoption Model (EMRAM). This designation indicates MHS Genesis can successfully process a significant percentage of lab orders, test results, and other data without the need for manual uploads of digital images or other media.
DoD is also still in the process of fine-tuning interoperability between MHS Genesis and other commercial EHR systems in the public and private sector. Cummings stated faxes, paper, and emailed images are still necessary to share data with some commercial systems.
Additionally, Cummings said there is no special interoperability functionality between MHS Genesis and outside Cerner systems in the private sphere. The federal agency is working with eHealth Exchange and CommonWell to improve health data exchange with other health systems.
As DoD processes feedback about interoperability, workflow, and other improvements, the federal agency is looking forward to system deployments in more challenging environments.
"The IOC sites provided us with breadth of the type of garrison military facilities we see in DOD, from small clinics to large medical centers," said Cummings. "We haven't gone forward with the operational theater solution."
In future phases of the MHS Genesis rollout, the federal agency will need to complete EHR implementations on ships, submarines, and other unconventional sites. Some care sites have no network connectivity.
"Clearly we do things that are not done in a commercial environment," Cummings said. "To test and really engineer around that low- and no-communications environment, to be distributed and offline and continue to do your job — that's where a significant engineering aspect comes in."