It has been a little over one year since MHS GENESIS, the U.S. Department of Defense’s new electronic health record, went live at Fairchild Air Force Base. That was followed by the remaining sites in the Initial Operability Capability (IOC) region, which also includes Naval Hospital Oak Harbor, Naval Hospital Bremerton and Madigan Army Medical Center. The Leidos Partnership for Defense Health is proud of the progress made to date, and we continue to learn and grow while transforming military health care.
Health care delivery is complex, and change at this level of scale is never easy. To help mitigate this, the DoD has adopted commercial practices for deployment: incremental phasing, focusing on a smaller set of facilities first to work through issues and make adjustments to make the larger outcome better. The Partnership has worked closely with DoD leadership, local staff and military health system providers to identify workflows, provide the right training to the right people and get end users accustomed to the new system and the new processes that inherently follow.
As can be expected with any large-scale change, there have been challenges. Some early adoption issues mean that change management and governance processes are being refined. Some issues logged have taken longer to resolve than we would have liked, and productivity at the local level has taken some time to normalize. Although we seek ideal outcomes, we also know how complex this type of delivery can be. The incremental approach anticipates these types of early concerns as a part of the deployment process and integrates steps to examine issues and develop long-term resolutions prior to full enterprise rollout.
Currently, the MHS GENESIS program is undergoing a planned optimization phase. We are working closely with the Partnership and the users in the Pacific Northwest to retrain, assist with change management, answer questions, address workflow where appropriate and resolve issues. We realize practitioners’ priority is the care of their patients, and want MHS GENESIS to be the tool that will allow them to accomplish that mission.
As the pace at which MHS GENESIS deployments take place, accelerate and overlap, it is imperative to have a fine-tuned deployment and adoption process that can be standardized across the entire span of defense health. MHS GENESIS is not just a single solution for a single facility. An enterprise project of this size must be implemented thoughtfully, and we are working closely with our defense health system users to make that happen.
Early adoption practices have led to operational improvements
As we strive for continuous improvement, it should be noted that there are many operational benefits. The IOC sites have functionality that they did not have prior to implementing MHS GENESIS, such as advanced clinical decision support, proactive care management, data analytics and built in clinical intelligence. In addition, the IOC sites are now able to share data with the community-based EHR systems and with VA health care providers through the agencies’ Joint Legacy Viewer. Here are some of the highlights:
- Since the deployment of MHS GENESIS, Fairchild Airforce Base has achieved Stage 6 on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM), a ranking that currently only 22 percent of outpatient facilities have attained. The designation puts Fairchild’s ability to support optimized patient care through efficient use of the EHR on par with levels obtained by leading commercial hospitals and clinics. Stage 6 is an important indicator that an organization is effectively leveraging the functionality of its EHR system. To achieve this level, the facility is required to demonstrate many technology functionalities that contribute to patient safety and care efficiency, including establishing a digital medication reconciliation process and a problem list for physicians, as well as demonstrate the ability to send patient preventative care reminders.
- Improved functionality including a new alert system has already resulted in direct impacts to patients' care regimens and safety. Within the first four months of going live on MHS GENESIS at Madigan Army Medical Center, the average length of stay for hospital patients experiencing sepsis has been reduced by 37 percent due to early recognition of sepsis risk alerts. Cerner's algorithm translates aggregated data to identify risk factors earlier in a patient's decline, and automatically moves sepsis-related clinical decisions up further in workflow. Providers can then provide early intervention to mitigate the potential deadly effects of sepsis.
- From June 2017 to January 2018, the IOC sites have cancelled 2,613 non-medication orders, potentially reducing the amount of duplicative procedures such as labs and imaging.
- From June 2017 to January 2018, order volume for IOC sites has increased and time spent placing orders per patient has decreased by approximately 8 percent. This means users are finding the workflows easier, which ultimately is improving efficiency and allowing for more time spent with the patient.
These early successes prove we are on the right track, but our job is never done and pursuit of improvement will never cease.
Cerner is committed to working with DoD to aid with the successful adoption of a single integrated military health record that improves access to a service member’s medical record today and throughout a lifetime of care. Learn more here.
MHS GENESIS and DoD facility outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models. The reader should not place undue reliance on forward-looking statements, since the statements speak only as of the date that they are made. Except as required by law, Cerner undertakes no obligation to update or revise forward-looking statements to reflect changed assumptions or status.
