DoD EHR Update Requires Mapping, Testing of Health IT Infrastructure

June 07, 2019 - The health IT infrastructure needs to be fully mapped and tested to ensure it can support the new electronic health record (EHR) system the Department of Defense (DoD) is implementing, testified Jon Scholl, president of Leidos Health Group.

Leidos is the contractor overseeing the DoD’s $5.5 billion EHR modernization known as MHS GENESIS, which is based on the Cerner platform.

“The underlying IT backbone – the networks, the computers, the printers, the medical devices – must be mapped and tested to support the new system. The implementation at our initial pilot sites identified the critical importance of validating and revalidating that the necessary infrastructure is in fact ready,” Scholl told the House Veterans’ Affairs Committee’s technology modernization subcommittee at a June 4 hearing.

Scholl said that this was one of the lessons learned during the pilot implementation of the MHS GENESIS system in the Pacific Northwest.   

Other lessons learned during the pilot involved training and personnel.

READ MORE: MHS GENESIS Eases Sharing of Medical Images Between DoD Facilities

“We refined our approach to training. The curriculum is now better aligned to clinical processes. We are using team-based, role-based, and just-in-time-based training methods,” Scholl said.

“The most challenging work ahead is not only the engineering to ensure that the underlying components continue to work in a secure environment, but also working closely with the dedicated medical staff to best implement the MHS GENESIS solution,” Scholl stressed.

VA EHR Modernization Is "Immense" Task, Says Cerner

Travis Dalton, president of Cerner Government Services, testified before the committee on his company's work modernizing the VA’s EHR system.

“This undertaking is immense. It carries risks, and we don’t take the challenges lightly,” he said.

Dalton related that Cerner will deploy its EHR system to 1,700 sites and train more than 300,000 VA employees, as well as collaborate with DoD, interoperate with community health organizations, aggregate decades of medical records, and update technology. The company is integrating 130 disparate health record systems into one integrated system.

READ MORE: Lawmakers Blast DoD Officials Over EHR Implementation Delays

Cerner has so far migrated 23 million veterans’ health records into the Cerner data center. He noted that the VA and DoD health data are in the same system.

Rep. Susie Lee (D-NV), chairwoman of the subcommittee, asked how Cerner and Leidos are ensuring that the DoD and VA EHR systems will be interoperable.

Dalton said that his team works closely with Leidos on the two EHR modernization projects, including holding joint working sessions and conducting joint workshops. In addition, there is an environment management operating group, including representatives from DoD, VA, Cerner, and Leidos, which works together on a regular basis.

Lee also asked Dalton about delays in Cerner decision making and whether it’s a problem with the VA and DoD governance structure.

“Clinical decision making is hard … We are getting into difficult decisions around referral management, processes, workflow. We are also making sure we get national representation and local representation as part of this process. Fine-tuning that is not always an easy thing to do,” Dalton said.

READ MORE: Byrne Says Aging Health IT Infrastructure Complicates VA EHR Rollout

In kicking off the hearing, Lee warned that the VA “does not have a great track record when it comes to implementing information technology.” She cited studies by the Government Accountability Office that demonstrated decades of problems with the VA’s IT modernization efforts.

“VA’s inability to manage IT programs and have accountable leadership has plagued many of its recent IT efforts, and it threatens EHR modernization. The lack of an accountable joint governance structure between the VA and DoD also threatens the success of this project,” Lee said.

Lawmakers Probes Interoperability between DoD, VA Systems

In response to a question about interoperability by Rep. Steve Watkins (R-KS), Dalton said that interoperability is more than just a technical challenge.

“There are a number of things that go into interoperability. We are bringing DoD and VA into a single instance domain. We’ve got VistA [VA’s legacy EHR] history that’s coming into the environment. We’ve got device integration real time. We’ve got reference lab and state PDMPs [prescription drug monitoring programs] for opioid risk scoring. And we’ve also got open, standards-based APIs. All of that is interoperability in our minds,” Dalton said.

Rep. Conor Lamb (D-PA) asked the Cerner representatives whether they needed anything from the DoD and VA to ensure that the implementation timelines are met.

David Waltman, vice president of strategy and technology at Cerner, said that there were several things that needed to be address so that his company can stay on schedule.

“We have to have a common cyber posture between the two environments. There are decisions that the Department of Defense needs to make in authorizing assessment strategies for some of the technology, for example, container technology, or other decisions regarding connections between the systems from VA to DoD. Although some of those decisions are in process, we have not seen those made at the speed we would like to be able to ensure that we maintain the expected schedule,” Waltman related.

Julie Stoner, director and client accountable executive with Cerner, added that her company would like a consistent joint decision-making process. “Things like results viewing. That has to be consistent across the agencies. How the Department of Defense takes on new capabilities that become available because the VA has provided them. And how we continue to push both agencies to move on a commercial baseline and take advantage of those investments.”