Providing an update on Cerner’s progress with the Department of Defense’s (DoD) electronic health record (EHR) implementations, a company executive noted that he is seeing “measurable progress” at the DoD’s initial operational capability (IOC) sites.
The EHR overhaul contract for the DoD, called MHS Genesis, and which was awarded in 2015 to Cerner, Leidos and others, is currently valued at $4.3 billion with a total contract lifecycle value of $9 billion if all options are exercised. And it was recently announced that the contract ceiling will be raised by $1 billion, and that the additional funding will include the Coast Guard in the project.
According to some media reports throughout this year, the initial feedback on the four military site EHR rollouts has been less than ideal. This past spring, a Politico report that detailed the first stage of implementations noted that it “has been riddled with problems so severe they could have led to patient deaths.” Indeed, some clinicians at one of four pilot centers, Naval Station Bremerton in Washington, quit because they were terrified they might hurt patients, or even kill them, the report attested.
In October 2017, Madigan Army Medical Center in Takoma, Wash. became the fourth military site to go live with the MHS Genesis EHR system. That deployment followed installations at Fairchild Air Force Base, Naval Health Clinic Oak Harbor and Naval Hospital Bremerton. The new EHR system is expected to be deployed at every military medical facility in phases over the next five years, and a recent report noted that the DoD is moving onto a second site of site locations.
Executives at the Defense Healthcare Management Systems, the office in charge of the EHR modernization projects, have expressed more positivity of late, despite the negative media reports. And now, in a federal update blog post, Travis Dalton, president, Cerner Government Services, stated that he recently visited the four DoD sites that have deployed the Cerner system, noting that he is “encouraged by the progress being made and the direction we are now headed. Even in this early stage, thanks to the leadership at each site, we’re seeing improvements in patient safety, patient care and efficiency. We are seeing measurable progress at the IOC sites,” he said.
Dalton pointed to specific areas of progress with use of the IT system, such as: approximately a nine-minute improvement in the time from when a patient arrives at the emergency department (ED) to when they see an ED provider in the first two months post go-live; avoiding approximately 2,300 duplicate orders of four commonly placed lab orders from January through June; avoiding more than 400 duplicate chest X-rays from January through August; and increasing the number of online portal messages between patients and their care teams by more than 40 percent in the first 60 days post go-live.
Dalton further noted that the number of patients seen in ambulatory locations has increased by 33 percent and the volume of necessary prescriptions and refills have increased by 65 percent at these sites.
Speaking to the hurdles that the initial implementation sites have experienced thus far, while Dalton did not mention any of the specific patient safety concerns mentioned in media reports, he said that “We’re well accustomed to the initial hurdles that come with a technology implementation. With the DoD, our goal was to identify challenges and fine-tune processes early, so we proactively sought feedback a few different ways.”
To this end, he said that the DoD’s Joint Interoperable Test Command conducted an Initial Operational Test & Evaluation at the four IOC sites, which “confirmed some of the challenges the team was already working to resolve. Though some have portrayed the report’s findings as a setback for the program, these reports accomplished exactly what we intended,” he said. Back in January, it was announced that the MHS Genesis rollouts would be suspended, with the goal to assess the successes and failures of the sites where the rollouts had already been deployed.
Meanwhile, regarding the VA modernization project, a $10 billion dollar contract that was also awarded to Cerner, back in May, Dalton stated that “Cerner and the agency are committed to applying commercial best practices, as well as any lessons learned from our DoD experience, to the VA’s Electronic Health Record Modernization (EHRM) program. The VA has unique challenges and it’s critical that end-users and stakeholders are engaged throughout the implementation process,” he said. Adding to this point, he noted that Cerner recently hosted more than 400 stakeholders, including Veteran Service Organizations, government officials from the VA, DoD, Office of Management and Budget, and industry partners at its company headquarters in Kansas City, Missouri for a program kickoff.
In a joint statement from the DoD and VA Secretaries about a month ago, the two agencies signaled their commitment to achieving interoperability by implementing a single, seamlessly integrated EHR. The hope inside the federal agencies is for both departments to standardize on Cerner’s EHR. The idea is that this will provide a more complete longitudinal health record and make the transition from DoD to VA more seamless for active duty, retired personnel and their dependents. Once completed, the project would cover about 18 million people in both the DoD and VA systems.
As Healthcare Informatics recently reported, while interoperability between the VA and DoD has been a long-standing goal for both agencies, and the past two decades has seen the agencies making strides to achieve interoperability between two separate health IT systems, progress on this front has been slowed by both operational and technical challenges.
Nonetheless, Dalton wrote in his post, “These efforts will achieve more efficient interoperability for the DoD and VA—creating a single health record across more than 1,700 health care sites and a lifetime of seamless care for nearly 20 million Servicemembers, Veterans and their beneficiaries. We’re in the early phases of this transformation. It’s a complex endeavor that will take time and involve asking passionate health care providers to change some of the processes they’ve been using for decades,” he said.