The U.S. Coast Guard wasted $60 million and seven years developing a health IT system that resulted in no equipment or software that could be used and a return to paper medical records.
July 01, 2019 – The U.S. Coast Guard wasted $60 million and seven years developing a health IT system that resulted in no equipment or software that could be used, according to the Government Accountability Office (GAO).
This health IT system project and other federal IT projects have suffered from a lack of disciplined and effective management, such as project planning, requirements definition, and program oversight and governance, the GAO judged.
“Executive-level governance and oversight across the government has often been ineffective, specifically from CIOs. For example, we have reported that some CIOs’ roles were limited because they did not have the authority to review and approve the entire agency IT portfolio,” the GAO commented in its report.
The Coast Guard ended up canceling the health IT system project, called the Integrated Health Information System (IHiS), in 2015 after decommissioning two legacy electronic health record (EHR) systems.
The head of the Health, Safety and Work-Life (HSWL) Directorate at the Coast Guard identified several financial, technical, schedule, and personnel risks with the IHiS project that led to its termination. Some of the risks with the IHiS project identified by HSWL director included:
Lack of testing: IHiS lacked an independent security assessment to verify that the system’s security infrastructure was adequate. In addition, full interface testing with systems such as the Defense Eligibility Enrollment Reporting System had yet to be completed to ensure security and data integrity.
Limited system functionality: The system that was to provide user verification and IHiS role management services had yet to be completed. In addition, Coast Guard workstations could not yet access IHiS from the network, and the patient portal lacked two-factor authentication. Further, the service that was to register new IHiS users in the system had yet to be completed.
Delays in the implementation timeline: The Defense Health Agency team projected the timeline for the first clinic implementation of IHiS would be approximately one year later than originally estimated. DHA said that the timeline was delayed, in part, because critical IHiS interfaces and workflows were not complete or operational.
As a result of the decision to cancel the IHiS project and shutting down the legacy EHR systems, Coast Guard clinics had to revert to using paper medical records for their 50,000 military members, the GAO said.
The challenges presented by the paper-based system included incomplete records, bad penmanship, problems tracking medications, amount of time needed to manage records, and limited ability to search within records.
The Coast Guard subsequently joined the DoD MHS GENESIS contract to deploy a Cerner-based EHR system. To incorporate the Coast Guard into the EHR implementation and to establish a standardized EHR baseline with the Coast Guard and the Department of Veterans Affairs, the DoD asked for a $1.2 billion increase in funding for MHS GENESIS based on the Cerner platform.
The standardized EHR baseline will include common off-the-shelf software, clinical application services, and interfaces, as well as shared infrastructure.
The MHS GENESIS system will replace legacy DoD EHR systems, such as the Armed Forces Health Longitudinal Technology Application, the Composite Health Care System, and components of the Theater Medical Information Program-Joint.
The new EHR system will provide two-way communication and integrated medical and dental records. It will monitor members’ health through better population health data, tracking, and alerts; improve the ability to track patient safety, outcomes, and readiness; expand access to and sharing of health data across military operations and veteran and civilian healthcare organizations; and increase accessibility of integrated, evidence-based healthcare delivery and decision making.