The Department of Defense hoped to complete its $4.3 billion EHR modernization project by 2022, but an April 30 report evaluating of the system's first pilot sites shows the EHR is "neither operationally effective nor operationally suitable."
The Department's Operational Test and Evaluation office found the agency's first three implementations of MHS Genesis, the Cerner-based EHR system selected by the DOD, failed to "demonstrate enough workable functionality to manage and document patient care" and had "poor system usability, insufficient training and inadequate help desk support."
"Users successfully performed only 56 percent of the 197 tasks used as Measures of Performance. Non-standard data and the failure to adhere to Interface Control Documents hampered information exchange with interfacing systems," the report reads.
The agency's rollout of the new EHR took a "wave model" in which military facilities in the Pacific Northwest began transitioning in February 2017. Later, in June 2017, the Department of Veterans Affairs announced it would overhaul its legacy EHR and move to the same system as the DOD. However, the VA has been slow to award Cerner the contract amid interoperability concerns, and the DOD paused its project for eight weeks beginning in January and later said it wouldn't resume the rollout until 2019.
The latest Pentagon report shows pilot users scored the system 37 out of 100 on the System Usability Scale, which is "well below the threshold of 70 that indicates acceptable usability," the report reads.
"Training was insufficient to overcome usability problems, and a lack of documentation forced users to develop their own operational workarounds," according to the report. "User survey comments from the three [initial operational testing and evaluation] sites reported similar problems that included undocumented and inconsistent workarounds, excessive system latency, inaccurate patient information, badly assigned user roles, poor user training, uneven assistance from on-site trainers and lack of visibility of the status of trouble tickets. Users from the four initial sites submitted 14,383 help desk tickets from January to November 2017, overwhelming the help desk's ability to resolve them."
Though cybersecurity testing is in preliminary stages, initial findings show the systems' threat detection and incident response were inadequate, and its data protection mechanisms were not in accordance with DOD standards.
The report also called the systems' scalability into question, citing user-reported lag times and standardization issues.
Robert Behler, director of the DOD's Operational Test and Evaluation office, recommends the agency continue its pause until full testing is complete and all issues are resolved.
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