$4B records system frustrates military doctors

Published 7:59 pm Friday, March 27, 2009

The Department of Defense’s $4 billion electronic health record system is so unreliable and difficult to use that military physicians list it among their top three reasons for leaving the service.

That fact came to light during a House armed services subcommittee hearing Tuesday, where senior medical officers and top Defense Department health officials described the problem-plagued system and the latest plans to reform it.

Lt. Gen. Eric Schoomaker, Army surgeon general, blamed the failures on “lack of a clear, actionable strategy and poor execution” from its inception. More pointedly, Schoomaker said the new blueprint for reform still lacks an overall strategy. He seeks deeper involvement in its design by the services and their health-care providers — the end users of an electronic health record system who have been victimized by poor design.

“Being the first service to vigorously support the fielding of (the system) five years ago, we faced a near mutiny of our health care providers — our doctors, nurse practitioners, physician assistants and others — last summer,” Schoomaker told the military personnel subcommittee.

Physicians complain the system is too slow, too cumbersome and confusing, with frequent crashes and sluggish acceptance of patient data. Clinicians list the system as their No. 1 professional frustration, with many saying they see fewer patients and have longer workdays, all because of the extra time it takes to do their jobs.

Though the system is used through the Defense Department, service medical departments have felt compelled to find their own methods in recent years to try to ease the headaches it creates.

“I would have to say candidly that at the provider level — the level of the doc, the nurse practitioner — they spend as much or more time working around the system as they do with the system,” said Schoomaker.

Medical officers emphasized that the potential benefits of electronic health records are profound. An accessible database on patient treatments and outcomes obviously improves continuity of care. But data on many thousands of patients also becomes, over time, an invaluable health surveillance tool, which can lead to reforms in medical practices, vastly improved learning and research, and better health care choices for patients.

The current system, Schoomaker said, is too flawed to achieve that full potential.

Despite the chorus of complaints over the years, defense leaders routinely praised or defended the system, usually pointing to the next fix or upgrade planned by Northrop Grumman, the main contractor.

That approach changed last summer when Dr. S. Ward Casscells, assistant secretary of defense for health affairs, held a Internet “town hall” on the system and got hundreds of complaints. He told Government Executive magazine that many providers clearly found the system “intolerable.”

So Casscells beefed up his information technology staff and instructed it to find a fix or an alternative. An early plan would modernize and reshape the system in three phases, subcommittee members were told.

Rep. Susan Davis, D-Calif., subcommittee chairwomen, opened the hearing by saying Congress has been “frustrated” by the Defense Department’s handling of the records system. “We expect to hear firm dates for the development and fielding of the fixes or new systems, as well as projected or already incurred costs,” she said.

Those expectations were not met during two hours of testimony.

Schoomaker listened to a lot of the discussion, then jumped in to say it wasn’t what he was seeking. He said any discussion of the fix needs to lay out in detail how the new architecture will improve providers’ ability to take care of patients and the health system’s ability to fulfill the full potential of electronic health records.

The services, “as customers and clients,” should have a powerful role in formulating and executing the strategy, Schoomaker said.

To comment, e-mail milupdate@aol.com, write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111 or go to militaryupdate.com.