Late Friday afternoon, the publication POLITICO published a report by Arthur Allen that reveals details of a Pentagon report on the Department of Defense (DoD) electronic health record (EHR) implementation project that experts who have seen it, say speaks to highly damaging issues with that rollout, problems that could impact the planned Veterans Administration Health (VA) implementation of a new EHR.
POLITICO reporter Arthur Allen wrote that “The first stage of a multibillion-dollar military-VA digital health program [EHR implementation] championed by Jared Kushner [in his White House role as director of the Office of American Innovation] has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO. The April 30 report,” Allen wrote, “expands upon the findings of a March  POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients, or even kill them. Experts who saw the Pentagon evaluation—it lists 156 ‘critical’ or ‘severe’ incident reports with the potential to result in patient deaths—characterized it as ‘devastating,’” Allen wrote on Friday, referencing the rollout of a commercial EHR at several naval bases. “Traditionally, if you have more than five [incident reports] at that high a level, the program has significant issues,” Allen quoted a member of the testing team as saying.
That DoD implementation involves a long backstory in itself. As Healthcare Informatics reported back in 2015, a team headed by the Kansas-City based EHR vendor Cerner Corp., and Reston, Va.-based Leidos, was awarded the massive Department of Defense Healthcare Management Systems Modernization (DHMSM) EHR contract, worth about $4.3 billion.
But this past January, DoD and Cerner said that they would be suspending the MHS Genesis modernization project for eight weeks. A NextGov report at the time noted that the pause in the EHR rollouts across DoD sites will allow those involved to “assesses the ‘successes and failures’ released to the field thus far. Meanwhile, Politico’s morning eHealth newsletter at that time also reported that there were currently “1,600 ‘open tickets’ from the early users of the system at four Washington state medical clinics and hospitals.” To this end, NextGov received word from a spokesperson for the Defense Healthcare Management System who said the DoD has actually received 17,000 “trouble tickets” from users at the four test sites, of which some 11,000 have already been addressed.
In October, 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. Madigan was the largest and last of four Pacific Northwest bases that make up the initial phase of the multi-billion-dollar Cerner implementation.
Meanwhile, in his Friday afternoon report for POLITICO, Arthur Allen continued, “The project’s price tag and political sensitivity—it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade—means it is ‘just another ‘too big to fail’ program,’” according to a testing team member. “The end result everyone is familiar with — years and years of delays and many billions spent trying to fix the mess,” that team member added. What’s more, Allen wrote, “The unclassified findings could further delay a related VA contract with Cerner Corp., the digital health records company that began installing the military’s system in February 2017. The VA last year chose Cerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service. The military program, called MHS Genesis, was approved in 2015 under President Barack Obama. In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November,” he added. One of the bases referred to is apparently Naval Station Kitsap (Naval Station Bremerton), in Washington state.
As Heather Landi wrote in a news report on the VA Health EHR implementation on Thursday, “Robert Wilkie, the acting secretary of the U.S. Department of Veterans Affairs, will make a decision on whether to move forward with an acquisition contract with Cerner for a new electronic health record (EHR) system by May 28, Memorial Day, according to VA leaders. During a Senate appropriations subcommittee hearing on Wednesday,” she wrote, “Jon Rychalski, assistant secretary for management and chief financial officer at the VA, provided lawmakers with an update on the timeline for the EHR procurement. The hearing was focused on the VA’s Fiscal Year 2019 budget request. During the same subcommittee hearing, several lawmakers raised concerns about what they called a ‘leadership vacuum’ at the VA and the ongoing delays with the EHR acquisition contract.”
What’s more, “[Wilkie] has said he is going to make a decision by Memorial Day,” Rychalski told lawmakers Wednesday, adding that Wilkie “came in cold” with regard to the VA’s EHR modernization. “He knew what was going on with DoD but not enough about the VA, and he wanted to do due diligence to make sure he was comfortable in making a decision of this magnitude,” Rychalski told members of Congress. “So that’s the reason for the second delay. Before that they were looking at the contract and interoperability and that was probably worthwhile because they came up with about 50 recommendations to improve it.”
As Landi noted in her article on Thursday, “It’s been almost a year since the VA announced that it will replace its aging EHR system, called VistA, by adopting the same platform as the U.S. Department of Defense (DoD), a Cerner EHR system. Since then, senators have pushed the agency for a timeline for the EHR project and for plans to ensure that the technology systems of the VA and DoD will be integrated. During an October House Committee on Veterans’ Affairs hearing, [former VA Secretary David] Shulkin told lawmakers that it will be seven or eight years before Cerner's EHR system is fully implemented throughout all VA locations.”