Electronic Health Records: DOD Has Deployed New System but Challenges Remain
Fast Facts
DOD provides crucial health care services to millions of service members, retirees, and their families. DOD has been working to modernize how it handles patients' electronic health records and has deployed a new electronic records system to its health care facilities.
In 2022, DOD began conducting an annual survey of user satisfaction with this new system. User satisfaction rates have improved over the past 2 years, but these rates are still lower than the rates for DOD's old health records systems.
DOD hasn't established goals for improving user satisfaction with this new system. We recommended, among other things, that it do so.
Highlights
What GAO Found
The Department of Defense (DOD) has deployed its new federal electronic health record (EHR) system, called MHS GENESIS, at military treatment facilities. The final system deployment took place in March 2024 at the Federal Health Care Center, a joint DOD and VA facility.
As of March 2024, DOD and VA reported that they had completed the 35 critical tasks and milestones required to implement the new system at the joint facility, but the departments have opportunities to further integrate their systems. Accordingly, DOD and VA began a process to resolve differences between their respective workflows and EHR configurations to increase integration. However, the process did not result in a fully integrated approach due to reasons such as legal and policy barriers. Until it addresses these barriers, DOD and VA will likely not meet the integration goal established for the Federal Health Care Center.
In 2022, DOD began conducting an annual survey of MHS GENESIS user satisfaction and worked with a contractor to analyze survey data. User satisfaction rates for DOD's new system have improved over the past 2 years. However, the user satisfaction rates for the new system were generally lower than the rates for users of DOD's legacy systems and for private-sector users of the commercial version of MHS GENESIS (see table).
User Satisfaction Results from DOD's 2023 Annual User Satisfaction Survey Compared to Results for DOD's Legacy Systems and Similar Private-Sector Systems
|
Survey question topic |
New electronic health record |
Legacy systems |
Private-sector systems |
|---|---|---|---|
|
Patient-centered care |
39% |
56% |
46% |
|
Efficiency |
20 |
36 |
32 |
|
Downtime |
49 |
45 |
67 |
|
Response time |
21 |
31 |
40 |
|
Quality care |
29 |
46 |
50 |
Source: GAO analysis of Department of Defense (DOD) information. │ GAO 24 106187
Note: DOD legacy system data come from 2022 survey results. Data for DOD's new electronic health record and for private-sector systems come from 2023 survey results.
Although user satisfaction levels are below those for its other relevant systems, DOD has not yet established satisfaction goals. Without goals for improving user satisfaction, the department will be limited in its ability to measure progress, plan for improvements, and ensure the system meets users' needs.
DOD's Program Executive Office has implemented an issue management plan to address key issues affecting MHS GENESIS. However, it has not been able to resolve problems with its dental module, called Dentrix. These problems, which began in 2018, continued to plague Dentrix through January 2024. This led to DOD elevating the issue to the severe level and deciding to identify Dentrix alternatives. However, DOD does not yet have a plan or schedule for identifying alternatives. Until the office resolves the Dentrix issue, the new federal EHR will not provide critical functionality to dentists who treat DOD beneficiaries.
Why GAO Did This Study
DOD's health care system is one of the largest in the nation, providing crucial services to millions of service members, retirees, and their family members. The department has taken major steps to modernize the EHR systems it uses to manage patient health information.
Federal law includes provisions for GAO to review DOD's EHR system modernization. This report examines (1) the progress DOD and VA have made toward implementing the federal electronic health record system at the Federal Health Care Center, (2) the extent to which DOD has identified user satisfaction with the system, and (3) the extent to which DOD has managed key issues affecting system implementation.
GAO analyzed agency documentation, such as implementation plans and results of user satisfaction surveys. GAO also reviewed program documentation on long-standing EHR-related issues, including issues with deploying the dental module. In addition, GAO observed monthly program management meetings where top program risks were discussed, interviewed department officials, and conducted a site visit to the Federal Health Care Center.
Recommendations
GAO is making four recommendations: one to DOD and one to VA to address integration barriers at the Federal Health Care Center, and two to DOD to establish user satisfaction targets and implement a plan to provide a dental module alternative. In written comments on a draft of this report, DOD and VA generally agreed with our recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of Defense should direct the Federal EHR Modernization Office to identify and address specific barriers to maximizing integration at the FHCC, consistent with the FHCC executive agreement. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should direct the Defense Health Agency Health Informatics organization in conjunction with the Program Executive Officer of Defense Healthcare Management Systems to establish MHS GENESIS user satisfaction targets (i.e., goals) and ensure that the system demonstrates improvement toward meeting those targets. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should direct the Program Executive Officer of Defense Healthcare Management Systems to develop and implement a plan to provide an alternative to the MHS GENESIS dental module. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should direct the Federal EHR Modernization Office to identify and address specific barriers to maximizing integration at the FHCC, consistent with the FHCC executive agreement. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|