David A. Powner, Director for Information Technology Management Issues at the General Accountability Office (GAO) https://www.gao.gov submitted testimony to the House Committee on Transportation and Infrastructure https://transportation.house.gov Subcommittee on Coast Guard and Maritime Transportation. GAO’s study (GAO-18-363T) summarizes information related to the Coast Guard’s EHR modernization initiative and the Coast Guard’s current health records management process.
In 2010, the Coast Guard initiated an effort known as the Integrated Health Information System (IHiS) to replace its aging EHR system with a new system that was to modernize various healthcare services for the nearly 50,000 military members. However, in 2015, the Coast Guard announced that the modernization project would be cancelled.
The GAO’s report discusses how the Coast Guard which is a military service within the Department of Homeland Security, obligated approximately $67 million for the IHiS project and had spent about $59.9 million at the time of the cancellation.
In addition over two years after the project’s cancellation, the Coast guard continued to pay vendors. The agency paid about $6.6 million to vendors between November 2017 and February 2018 to meet existing contractual obligations for services.
Currently, the agency’s clinical staff performs various manual steps to process each paper health record. Today, the clinical staff schedules appointments for patients by using Microsoft Outlook’s calendar feature and provides the patient with paper forms to complete upon arrival. Also, the staff must handwrite clinical notes in the paper health record during the appointment, as well as handwrite prescriptions.
Challenges have resulted in incomplete records, penmanship can be difficult to read, it can be difficult to track medications, and managing paper health records requires more time for staff to complete and file the paperwork.
The Coast Guard has been taking steps to acquire a new EHR system referred to as the “Electronic health Record Acquisition (eHRa). These steps include:
- Determining the need for a new EHR system as identified in 2016 and obtaining approval for the first of three Acquisition Decision Events (ADE)
- Initiating market research activities to collect information on costs, schedules, and capabilities from commercial and government solution providers including DOD and the VA
- Completing an alternative analysis report completed in October 2017 recommending a solution based on performance, risk, costs, and advances in scheduling
- Finalizing life cycle cost estimates by the Acquisitions Directorate is also in the process plus developing a project plan for eHRa documents that are necessary to ensure that appropriate business decisions will be made regarding eHRa’s logistics, affordability, and resources
As of December 2017, the Coast Guard had not yet made a final determination as to which option will be chosen as the solution for the eHRa acquisition.
The GAO report recommends:
- Coast Guard to expeditiously and judiciously pursue a new EHR system
- Ensure that key processes are implemented
- Establish project governance boards
- Document lessons learned from the IHiS project