Coast Guard goes back to drawing board with new EHR

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Following a failed electronic health record implementation, the U.S. Coast Guard is currently conducting an acquisition process that is considering both government and commercial EHRs as possible solutions.

“After wasting more than $66 million over a five-year period, the Coast Guard cancelled its electronic health records effort, referred to as the Integrated Health Information System project,” said Rep. Duncan Hunter (R-Calif.), chairman of the House Subcommittee on Coast Guard and Maritime Transportation, during a hearing this week. “The service has nothing to show for the time and money expended and finds itself in a worse position than before it awarded the first contract almost eight years ago.”

In her testimony before the subcommittee, Rear Admiral Erica Schwartz, director of health, safety and work-life for the Coast Guard, said the service “sincerely” regrets the botched development of IHiS by several contractors, which she described as a “simple” EHR that “increased in scope and expanded into a much larger concept.”

While Schwartz testified that the project was well intentioned as a software-as-a-service initiative, she acknowledged that it “lacked appropriate oversight and governance,” resulting in “significant mission creep, untimely delays and increased cost.”

A Government Accountability Office audit released this week found that financial, technical, schedule and personnel risks led to the Coast Guard’s decision to cancel IHiS and that the service allowed program managers to handle the project without sufficient oversight by acquisition professionals.

Schwartz told lawmakers that the Coast Guard has learned valuable lessons from the failure of IHiS, which the service is incorporating into its plans as it moves forward with a new EHR project.

Still, Hunter lamented the fact that the Coast Guard is currently “handling all medical information using paper records—records that cannot be shared with the Department of Defense or Department of Veterans Affairs systems.”

David Powner, GAO’s director of information technology management issues, told the subcommittee that “using paper is inefficient and dangerous.”

In response, Schwartz said the service’s decision to stick with paper medical records for the time being was driven by the fact that the Coast Guard’s “outdated” legacy EHR had significant IT security concerns.

At the same time, she acknowledged the “risk of managing a medical program based on paper health records, whether it’s the challenges of scheduling an appointment, difficulty in reading handwritten clinical notes, storing volumes of information or decreased productivity,” adding that the Coast Guard cannot continue long-term without an EHR.

Schwartz testified that it is the service’s goal to acquire and implement a system as soon as possible that is “interoperable with the DoD and one that allows our members to efficiently transition to the VA.”

The DoD and VA are looking to create a common shared EHR. DoD’s system—called MHS GENESIS—leverages the Cerner Millennium platform, as will the VA’s EHR, after the agency concludes contract negotiations with the vendor. The intent is to create a lifetime health record that will facilitate the transition of active duty military members to veteran status.

Also See: VA delays EHR award to Cerner pending interoperability assessment

Rear Admiral Michael Haycock, the Coast Guard’s assistant commandant for acquisition and chief acquisition officer, testified that the service is “in close contact with DoD and VA” to ensure that its new EHR is interoperable with their systems. Haycock said the Coast Guard is conducting market research to gather data on the cost, schedule and performance capabilities of potential commercial EHR solutions.

However, GAO’s Powner told the subcommittee that despite issuing a request for information to industry last April, the service has yet to determine a specific EHR solution. He recommended that the Coast Guard “needs to strongly consider” the Cerner system that the DoD and VA are pursuing.

Chairman Hunter agreed that it made sense for the Coast Guard to adopt Cerner’s Millennium EHR. “The Coast Guard’s a military service, right? Why wouldn’t you go with DoD in the first place? Why not be interchangeable with DoD? Why not save all that money and time and be efficient and use DoD’s product?” he asked.

Schwartz replied that the Coast Guard is “looking with great interest at what DoD is doing and what the VA is doing” as part of the service’s acquisition process that includes a review of various government- and commercial off-the-shelf EHR solutions, adding that she “would love to go with DoD and the VA.”

When pressed by Hunter as to why the Coast Guard would even consider a system other than Cerner’s Millennium platform, Haycock emphasized that the service must go through the acquisition process, which includes an analysis of different options and “prevents us from getting in trouble (like the) messes” experienced with the IHiS project.

Nonetheless, Hunter reiterated that he “highly encouraged” the Coast Guard to “do what’s easy, efficient and effective” by selecting the Cerner EHR, “especially when you’ve got really big services with lots of money doing it for you—then you can just piggyback onto that.” He added, “I’m of the mind of making you get on DoD’s thing no matter what you think—we ought to just tell you to do it. You don’t need to be going off and doing your own thing when it comes to healthcare.”

Haycock noted that the Coast Guard expects to make a major acquisition decision by the end of the month.

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