New military e-health record system to begin at Fairchild

by Tom Philpott

Next February, two months past a deadline set by Congress, Defense officials and industry partners will begin to field test a new military electronic health record system at a single site, the clinic-sized hospital on Fairchild Air Force Base near Spokane.

Congressional overseers of this long-awaited capability aren’t upset by the missed December start at Fairchild, or by a rescheduling of e-health record launches at three larger base hospitals across the Pacific Northwest.

Credit that calm to a wellspring of optimism on Capitol Hill over the new e-health records system called MHS GENESIS. Its acquisition team is seen as making all the right early moves to ensure a successful “wave” rollout of the $4.3 billion project across the entire Military Healthcare System, including sickbays on ships at sea, by target year 2022.

“Replanning” the initial site deployments, confirmed this week by Stacy Cummings, program executive officer for the Defense Healthcare Management System, is drawing praise rather than sounding alarms.

“It’s very responsible,” said a congressional staff member who was briefed on changed initial launch dates. “We want a good system. They identified some process issues they’re working on. They’re taking the right amount of time. And instead of rolling out a broken system, they’re going to roll out a good system we have high hopes for. Everything we’re hearing about it is very promising.”

That was far from the prevailing view in Congress by May 2013 when then-Defense Secretary Chuck Hagel shifted responsibility for developing a single e-health record system from his health affairs office to Frank Kendall, undersecretary of defense for acquisition. Hagel even halted solicitation of bids from commercial e-record vendors, telling lawmakers, “I didn’t think we knew what the hell we were doing.”

Kendall quickly created the DoD Healthcare Management System Modernization Program to oversee development of an e-health record that could handle military unique needs, absorb data from several legacy systems and most importantly use off-the-shelf commercial software and technology.

The program team organized groups of military clinicians by specialty to review existing commercial software and agree on standardizing workflows across the health system, attacking the way-we’ve-always-done-it mindset of Army, Navy and Air Force medical departments. Kendall’s acquisition team appears to be succeeding where the health affairs office failed in part because it forced its client, the military health system, to set reasonable requirements rather than pile them on based on service-unique habits.

The effort was helped by the simultaneous creation of the Defense Health Agency, which set out to streamline health care delivery operations across separate Army, Navy and Air Force medical departments.

In July 2015, the program office awarded a $4.3 billion, 10-year contract to Leidos Inc. and industry partners to deliver and support a modern interoperable electronic health record system for 9.4 million beneficiaries and 205,000 medical personnel and staff.

The Leidos Partnership for Defense Health, as the vendor is called, will use two popular commercial systems — Cerner Millennium for medical records and Henry Schein’s Dentrix Enterprise for dental – modified to interface with data from DoD legacy systems. These include the medical treatment records of ALHTA; pharmacy, radiology and laboratory orders gathered by the Composite Health Care System, and clinical information of Essentris as it was customized to support military inpatient care.

During a conference call with several news outlets Tuesday, Cummings explained why the initial simultaneous rollout of MHS GENESIS at Fairchild and Naval Hospital Oak Harbor at Naval Air Station Whidbey Island wouldn’t occur this December. Fairchild will launch in February and Oak Harbor by June “to have the best possible user experience for clinicians and beneficiaries” and “for long-term program success.”

Deployment of the new e-health record at Madigan Army Medical Center on Joint Base Lewis-McChord and at Naval Hospital Bremerton will not happen in February as planned, but by June, Cummings said. One payoff for the delays will be deployment of more robust initial capabilities at Oak Harbor, Bremerton and Madigan than originally planned, she said.

The Defense Department’s Inspector General issued a report last June that the rollout schedule for these Northwest facilities was at risk of being missed given remaining challenges to test how legacy systems interface with MHS GENESIS, to secure it against cyber attack and to ensure that the fielded system works correctly with all users properly trained.

Cummings conceded the initial schedule was “very aggressive” and that recent testing “identified issues that lead us to determine additional time was needed to ensure the best possible solution.”

These delays won’t affect “the previously announced full deployment target of 2022,” Cummings added. “The time we invest … now will help ensure success in the future, and provide the best possible user experience to our beneficiaries and health care providers.”

Providers will get a much simpler, easy to use and common sense e-health record system. Beneficiaries will be able to access health information easily and quickly, and the records should transfer to private sector providers or into the VA system smoothly.

Cummings said the DoD and VA already transfer more health information between their systems, using a Joint Legacy Viewer, than any major health systems. Data transfer is robust enough that the departments certified to Congress last April the interoperability of current medical record systems.

Cummings and Dr. Paul Cordts, “functional champion” to the MHS GENESIS program for the Defense Health Agency, said providers and beneficiaries are going see vast improvements. Patients will have a single medical record regardless of whether their episodes of care are as inpatients, outpatients, emergency care users or battlefield casualties, Cummings said.

“That means all of the data [will be] accessible to the medical professional when they need it, in a format they can use, to provide better care.” And by standardizing care, it will drive out variation in care delivery that can affect quality, Cummings added.

Cordts said MHS GENESIS also will allow military medicine to monitor adherence to clinical practice guidelines and also look beyond “episodic health care” to spot trends or best practices that will result in healthier beneficiary populations.

The program office hasn’t released an MHS GENESIS deployment schedule beyond the four initial sites. Lessons learned there, and follow-on testing, will inform the full deployment schedule by region and target dates.

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