The decision to replace the U.S. Department of Defense’s outdated ALTHA was one embraced by officials and its clinicians, who often complained of disparate systems that couldn’t speak to each other. The tech was also far too expensive to maintain.

DoD officials spent three years planning the replacement, and when the last of the four test sites went live in October at the Madigan Army Medical Center, everyone waited anxiously to see what would happen next.

Officials have been relatively quiet on the project, outside of a few media calls in the fall that hailed current progress. But recent reports have said the silence is due to a pause while the agency handles the mass amount of user complaints.

[Also: Cerner DoD overhaul coming out in waves; VA deal means 'single system' approach]

However, this lull period is no pause, nor was the assessment unplanned. In response to whether he could confirm recent reports the project was “paused,” DoD Defense Healthcare Management Systems’ Communications Director David Norley said, “Deny.”

“No one has stopped using MHS Genesis,” Norley said. “We’re not slowing our efforts on MHS Genesis: We’re full steam ahead.”

Planned assessment

In order to address some of the concerns brought to light by users, project managers are looking at all four site configurations, Norley explained. Project officials are taking user feedback and adjusting workflows -- and in some cases adjusting software.

Further, the team has focused its efforts on updating the configuration of the test sites, assessing the issues and tech in order to prepare for the next wave of deployment. Norley said that once the configuration is set up, the next wave of rollouts will continue.

But this period of “lull” shouldn’t come as a shock. This assessment period was actually part of the original plan. In fact, the 8-week period is actually truncated from the original intent.

[Also: VA to require Cerner prioritize interoperability, secure data exchange in EHR project]

“We always knew we were going to have to make adjustments to the system,” said Norley. Initially, the plan was to roll out all four sites within four months in Oct. 2016, and “then take 10 to 11 months for adjustments… But we shifted the schedule as it took a lot of time for those sites to get online.”

In May, the assessment period will conclude and the program will go into a critical review -- the final stage explained Norley. Leadership at all four sites will get together to approve the pieces of the system that are functioning -- and those that aren’t.

User complaints

As for the reports on site of user unhappiness, Norley said he believes there’s been a “misunderstanding of what we’re actually doing.”

The trouble is that some sites like Fairchild Air Force Base have been operating on the system for more than a year. Perhaps some users came in excited to work with the program, but found issues and reported it to the ticket system, he said. 

Norley admitted that not all tickets have been resolved or responded to as DoD has received at least 17,000 user complaint tickets since the project launched last year. Officials have addressed 11,000. 

[Also: Congress is trying to ensure interoperability between VA, DoD]

“It’s not like there hasn’t been any action,” Norley said. “If there was a critical user concern, of course, we made the change.”

The way the system is set up, the user dictates whether an issue reported is critical. Norley said the trouble is that while the user may find that issue critical, those in Washington, D.C. may not. 

However, while those tickets may not have been responded to in the way the user intended, all issues will be addressed during the critical review period.

“I can understand why that would be unfulfilling,” said Norley. “You’re trying to do business, and what you’re not getting is the feedback.”

But a change at one site makes changes to the entire enterprise, so Norley stressed that those major changes are being included in the assessment period. Officials have taken consideration all workflows and where the platform would be at the end of the project.

To Norley, it’s important now to make those adjustments to training and how the system is set up, in order for officials to sign off on the project -- and further the rollouts. The initial rollouts have all been part of a planned test phase for the EHR project, to make sure the agency gets it right.

“We’re going to have some software changes. And there will be a release in the next few months that will address those changes,” said Norley. “And we’re going to take a look of how we trained and how we could do a better job to make better preparation for the next wave that happens.”

“Did we get everything right? No. But it’s functioning,” he continued. “Once we get the configurations dialed in a little better, we can also provide feedback to those end users.”

And Norley stressed part of those adjustments will likely be made on the ticket system to address those user concerns.

“In the future, our issue evaluation process will be a lot smoother,” Norley said. “There are a lot of wickets to go through, and I think we’re coming up with how to be more agile on how we deal with those responses.”

Interoperability with VA

It’s crucial DoD gets it right. Congress has pressed the agency to improve its system -- and its interoperability with the Department of Veterans Affairs for years. Efforts to work together in the past have failed, but it seems both agencies have turned the page and are dedicated to creating an interoperable system for its 16-17 million constituents.

But while VA Secretary David Shulkin, MD, has pushed back the timeline for signing its own Cerner EHR contract due to interoperability concerns, Norley stressed the VA’s decision has had no impact on the DoD project.

While Shulkin is looking for the best system to work across the public and private sector, Norley said the DoD’s MHS Genesis has a unique configuration. The agency implemented a number of interoperability goals and for now the agencies share data with its legacy eHealth exchange.

“Once the VA locks down its configuration, we’ll definitely be working with the VA to make sure Genesis is the most interoperable system in the U.S.,” said Norley. “Linking arms with the VA, that’s a strong voice for how those systems exchange information with the private sector and the government.”

The next stage of MHS Genesis rollouts are planned for late spring in Southern California.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com