In a recent report, GAO named the health IT system in use at HHS among the 10 federal legacy systems most in need of modernization to prevent security problems.
By Kate Monica
June 12, 2019 – The Government Accountability Office (GAO) urged HHS to modernize its 50 year-old health IT system in a report naming the ten federal legacy systems most in need of significant upgrades.
The health IT system, implemented in 1969, was ranked third on the list of ten outdated IT systems in need of revamping. The EHR system supports healthcare delivery for the Indian Health Service (IHS) and is considered a highly susceptible to security threats.
IHS uses the clinical and patient administrative information system to gather, store, and display clinical, administrative, and financial information about patients visiting its clinics and hospitals. Due to the sensitive nature of this information, HHS officials stated that a modernization effort is “imperative.”
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Specifically, HHS officials interviewed by GAO said the system’s technical architecture and infrastructure are outdated, obstructing the federal agency’s efforts to fulfill regulatory requirements.
The EHR system software includes 50 additional modules implemented over time to keep pace with the changing demands of the evolving healthcare system.
“The software is installed on hundreds of separate computers, which has led to variations in the configurations at each site,” wrote GAO in the report. “According to HIS, this type of add-on development becomes detrimental over time and eventually requires a complete redesign to improve database design efficiency, process efficiency, workflow integration, and graphical user interfaces.”
System variations negatively affect interoperability and health data exchange between IHS employees. Replacing or modernizing the EHR system would help to boost interoperability with other healthcare organizations and facilities and improve care coordination for patients within the IHS network.
IHS officials expressed an interest in modernizing the EHR system earlier this year, but officials have not yet developed concrete modernization plans.
In September 2018, HHS awarded a contract to conduct research related to modernizing its health IT infrastructure, applications, and capabilities.
“According to the department, the research will be conducted in several stages over the next year, and a substantial part of the research will be an evaluation of the current state of health IT across IHS’s health facilities,” wrote GAO.
“Once the research is conducted, in consultation with IHS and its stakeholders, the contractor will use the findings and recommendations to propose a prioritized roadmap for modernization.”
HHS officials stated the agency expects to complete its modernization initiative in the next five years, and anticipates launching an EHR implementation plan as early as 2020.
While the federal agency has taken some steps to initiate a modernization effort, HHS has not calculated a potential cost for the project.
“With regards to potential cost savings, HHS noted that the modernization will take significant capital investment to complete and it is unknown whether the modernization will lead to cost savings,” noted GAO.
Launching an EHR modernization project at IHS would help to promote care coordination and data sharing between IHS, VA, and the Department of Defense (DoD.)
VA and DoD are currently in the process of replacing their legacy health IT systems with a Cerner EHR platform.
“HHS officials stated that this modernization could improve interoperability with its health care partners, the Department of Veterans Affairs and the Department of Defense, and significantly enhance direct patient care,” GAO officials wrote.
In 2017, IHS issued a request for information (RFI) to inform an EHR modernization effort. The RFI was part of the federal agency’s exploratory market research effort to assess health IT industry innovations and capabilities.
IHS provides healthcare services to American Indians and Alaska Natives per provisions established by the relationship between the federal government and Indian tribes in 1787.
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