In an earnings call to discuss its Q3 results this past week, officials from Cerner offered new information about the ongoing electronic health record modernizations it's rolling out at the U.S. Departments of Defense and Veterans Affairs.

Both are proceding at different paces, they said, but valuable lessons are being learned along the way at each.

After initial deployments at four DoD sites in the Pacific Northwest that saw their share of hiccups, MHS Genesis is ready for the next wave of installs at four more Air Force and Navy sites on the West Coast, said John Peterzalek, Cerner's chief client officer. "We believe these sites will benefit from the optimization efforts that followed our initial go-lives," he said.

As for the VA, Cerner is "on track to steadily ramp our work on the project as we finish 2018 and move into 2019," he added. "The first major project milestone will be in 2020, when initial sites are scheduled to go-live."

"We're pretty early in that process," added Marc Naughton, Cerner's chief financial officer. "But once it really cranks up, we're still a little early on deciding exactly what share that we'll perform and what share our partners will perform." He explained that the ramp-up "is not necessarily going to be linear. It could be a little bit lumpy depending on what work is being done, kind of slower start. And then once it gets up to scale, there's a lot to do."

Change management is key, says DoD lead

In a podcast posted to the Cerner website on Monday, Stacy Cummings, program executive officer for Defense Healthcare Management Systems, who's overseeing the MHS Genesis implementation, gave her perspective.

As the DoD rollout moves next past its initial operational capability phase in Washington State, Cummings said there have been some valuable lessons learned about EHR configuration, workflow, change management, training and adoption that will be brought to the next stages of the project.

One of the big ones, she said, is that "you need to make sure you have a good network infrastructure in place for MHS Genesis to be as reliable and speedy and efficient as possible." At first, she explained, IOC sites didn't leave enough time between ensuring network stability going live with the EHR, and that posed some big challenges.

Along with having a robust network, "cybersecurity is so important," said Cummings, who said the top priorities for MHS Genesis are "patient safety and keeping patient's data secure."

But perhaps the biggest takeaway from the first stage of the project, learned the hard way as many clinicians struggled with new technology and new workflows, is the importance of change management and training, she said.

"Our original change management and training structure focused a little too much on how to use the system and not enough on how the workflow will differ from legacy, where it was a lot more based on putting content into the system, to MHS Genesis, which is really a workflow-based, role-based system," said Cummings.

From the Pacific Northwest, the next step is to moving down the coast, with new Cerner rollouts at four new bases in California, she said: Travis Air Force Base (the largest of the four), Mountain Home AFB, Lemoore Naval Air Station and Monterey AFB.

The projects will build on some successes already occurring at the IOC sites – Cummings mentioned high uptake of patient portal and secure messaging, barcoding compliance at 85 percent and a tightly integrated inpatient-outpatient ED system – but will also incorporate some hard-earned wisdom from some of the challenges faced in Bremerton, Fairchild, Madigan and Oak Harbor.

"We're really looking at our network stability schedule and basing our schedule on that," rather than vice versa, she explained. "With network stability for six months. We'll be able to use the system during training the same way we'll be able to use it when we're actually operational."

And when it comes to change management, lessons learned from the pilot sites will be crucial, said Cummings. But "not just to apply them and move on," she said. "Apply them and test again. See where we got it perfect, and where we need to do a little more work to make it the best possible solution for our users and our beneficiaries."

At VA, hard work gets under way

In a blog post Tuesday, Travis Dalton, president of Cerner Government Services, gave his own update on MHS Genesis – he pointed to efforts to "identify challenges and fine-tune processes early," working with the DoD’s Joint Interoperable Test Command – and also indicated that some of those learnings will be applied to the rollout at the VA.

"Cerner and the agency are committed to applying commercial best practices, as well as any lessons learned from our DoD experience, to the VA’s Electronic Health Record Modernization program," said Dalton. "The VA has unique challenges and it’s critical that end-users and stakeholders are engaged throughout the implementation process."

As for next steps, he said the wisdom gleaned from the DoD project has left Cerner well-positioned for the VA rollout, where the "work is only beginning."

Cerner is "continually engaging their leaders and end-users through local workshops and site reviews that are critical to implementation at their IOC sites," said Dalton. The modernization project will "have ongoing innovation and health information exchanges among military and Veteran care facilities and thousands of civilian health care providers throughout the program."

It's been three years since work began in earnest on MHS Genesis. Now that Cerner is getting down to brass tacks on the VA project too, the company is clear-eyed about the large task it (and its partner, Leidos Partnership for Defense Health) faces.

"We know the commitment a complex IT installation requires," said Dalton. "We also know that there will be hurdles to overcome."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com