December 10, 2022

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Electronic Health Records: DOD Has Made Progress in Implementing a New System, but Challenges Persist

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<div>What GAO Found The Department of Defense (DOD) made progress toward implementing its new electronic health record system, MHS GENESIS. DOD deployed the new system to sites in six of 24 planned deployment phases (i.e., waves), which included about 41,600 users (see figure). DOD also improved system performance and addressed issues experienced at the initial sites. Even with this progress, incidents identified during testing—such as system defects—remain unresolved. DOD has not developed plans to conduct additional testing at future sites to ensure the remaining incidents are fully resolved. As a result, unaddressed incidents could lead to challenges at future sites. Actual and Planned MHS GENESIS Deployments, 2017-2023, as of June 2021 Additionally, implementation of MHS GENESIS faced training and communication challenges. Test results and selected system users indicated that training for MHS GENESIS and the dissemination of system change information were ineffective. For example, the users stated that training was not consistent with the “live” system. Further, users reported that there were too many system changes to keep up with and that they were not adequately informed as changes were implemented. As a result, users were unaware of important changes to their roles or business processes, or to system revisions and improvements. These challenges could hinder users' ability to effectively use the system, impede their knowledge of new workflows, and limit the utility of system improvements. Regarding key program risks, DOD identified and was tracking risks and their associated mitigation plans. Why GAO Did This Study DOD relies on multiple legacy electronic health record systems to create, maintain, and manage patient health information. DOD has determined that these systems, implemented over the past 3 decades, require modernization and replacement. The department has sought to replace these legacy systems with a comprehensive, real-time electronic health record. The conference report accompanying the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 included a provision for GAO to review DOD's electronic health record deployment. GAO's objectives were to (1) determine what progress DOD has made toward implementing a new electronic health record system, and (2) identify the challenges and key risks to MHS GENESIS implementation and what steps DOD is taking to address them. To do so, GAO analyzed test reports, briefing materials, and incident report tracking documents. GAO also held discussion groups with 356 users at selected sites and interviewed relevant officials.</div>

What GAO Found

The Department of Defense (DOD) made progress toward implementing its new electronic health record system, MHS GENESIS. DOD deployed the new system to sites in six of 24 planned deployment phases (i.e., waves), which included about 41,600 users (see figure). DOD also improved system performance and addressed issues experienced at the initial sites. Even with this progress, incidents identified during testing—such as system defects—remain unresolved. DOD has not developed plans to conduct additional testing at future sites to ensure the remaining incidents are fully resolved. As a result, unaddressed incidents could lead to challenges at future sites.

Actual and Planned MHS GENESIS Deployments, 2017-2023, as of June 2021

Additionally, implementation of MHS GENESIS faced training and communication challenges. Test results and selected system users indicated that training for MHS GENESIS and the dissemination of system change information were ineffective. For example, the users stated that training was not consistent with the “live” system. Further, users reported that there were too many system changes to keep up with and that they were not adequately informed as changes were implemented. As a result, users were unaware of important changes to their roles or business processes, or to system revisions and improvements. These challenges could hinder users’ ability to effectively use the system, impede their knowledge of new workflows, and limit the utility of system improvements. Regarding key program risks, DOD identified and was tracking risks and their associated mitigation plans.

Why GAO Did This Study

DOD relies on multiple legacy electronic health record systems to create, maintain, and manage patient health information. DOD has determined that these systems, implemented over the past 3 decades, require modernization and replacement. The department has sought to replace these legacy systems with a comprehensive, real-time electronic health record.

The conference report accompanying the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 included a provision for GAO to review DOD’s electronic health record deployment. GAO’s objectives were to (1) determine what progress DOD has made toward implementing a new electronic health record system, and (2) identify the challenges and key risks to MHS GENESIS implementation and what steps DOD is taking to address them.

To do so, GAO analyzed test reports, briefing materials, and incident report tracking documents. GAO also held discussion groups with 356 users at selected sites and interviewed relevant officials.

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