Unless the Defense Department addresses weaknesses in project planning and management that have hampered its current electronic health-record system's capabilities, it risks undermining its new EHR initiatives, according to a
Government Accountability Office report (PDF) requested by Sen. Judd Gregg (R-N.H.), the ranking minority member of the Senate Budget Committee.
The report notes how the Defense Department has obligated some $2 billion since 1988 to an EHR system for the 9.6 million active-duty service members, their families and other beneficiaries but has come up short and has scaled back its original expectations for AHLTA. (AHLTA was originally an acronym for "Armed Forces Health Longitudinal Technology Application," but the department
later declared it was no longer an acronym, but a brand.)
After finding AHLTA's
early performance "problematic" in terms of speed, usability and availability, the Department of Defense has sought to acquire a new system known as EHR Way Ahead, according to the report.
The new system, according to the GAO report, "is expected to address performance problems; provide unaddressed capabilities such as comprehensive medical documentation; capture and share medical data electronically within DOD; and improve existing information sharing with the Department of Veterans Affairs," and has initiated efforts to "stabilize" AHLTA so it can act as a bridge until the system is ready.
The Defense Department has allocated $302 million in its 2011 budget request, according to the report, but has not changed its EHR acquisition process to avoid the same shortcomings it experienced with AHLTA.
Read more here.
These included not establishing a comprehensive project-management plan, not having a tailored engineering plan, having incomplete requirements that "did not sufficiently reflect user and operational needs" and not developing an effective plan to improve user satisfaction.
The report also noted how 11 noncompetitive contracts and task or delivery orders were awarded to develop the system. Between fiscal 2004 and through 2012, these contracts and orders totaled $44.6 million.
To avoid repeating the mistakes made developing AHLTA, the GAO recommended that the department take six actions:
- Develop and maintain a comprehensive plan that includes information on project scope, cost, schedule and risks.
- Develop a systems engineering plan.
- Ensure that system users are involved in the development process.
- Ensure that system-level requirements can be traced both backward to high-level operational requirements, and forward to low-level system design specifications.
- Develop and document a plan for improving user satisfaction, including schedules for improvement and user feedback surveys.
- Management processes should by in sync with industry best practices such as identifying milestones and a completion date for external evaluation.
"As DOD continues to invest significant resources in a stabilization effort to address shortcomings of AHLTA and plan for the acquisition of a new electronic health-record system, it is imperative that the department take immediate steps to improve its management of the initiative," the report concludes. "Until it does so, it risks a continuation of the problems it has already experienced."
In a letter to the GAO, Deputy Assistant Defense Secretary George Taylor Jr. wrote that the Defense Department will address each of the recommendations, but said it "takes exception to several inaccurate, misleading and subjective statements provided" in a draft it received of the final GAO report.
