An April 2024 U.S. Government Accountability Office (GAO) report on Department of Defense EHR deployments found that user satisfaction levels are below those for its other relevant systems, and that DOD has not yet established user satisfaction goals.
The GAO report stated that 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.
The 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. In June 2017, VA initiated its EHR modernization program to replace its legacy system with the same Oracle Health EHR system DOD acquired.
In preparing its report, GAO studied results of user satisfaction surveys, and 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.
The GAO report highlighted several issues related to user experience in surveys about MHS Genesis:
• Patient-centered care. About 35 and 39 percent of MHS Genesis users in 2022 and 2023, respectively, agreed that the system enabled patient-centered care compared to 56 percent of legacy system users and 46 percent of private-sector users of the same commercial system as DOD.
• Downtime. In 2023, 49 percent of users indicated that the EHR was available when needed and that downtime was not a problem. This was almost double the amount reported in 2022 (25 percent). The 2023 survey numbers surpassed those of legacy system respondents, which was 45 percent. Nevertheless, the GAO noted, these responses lagged behind the 67 percent of private-sector users of the same commercial system as DOD who indicated that downtime was not a problem.
• Response time. In 2022 and 2023, 15 and 21 percent of MHS Genesis users, respectively, agreed the electronic health record had a fast response time compared to 31 percent of legacy system users and 40 percent of private-sector users of the same commercial system as DOD.
• Quality care. In 2022 and 2023, 24 and 29 percent of MHS Genesis users, respectively, agreed that the electronic health record enables them to deliver high quality care, compared to 46 percent of legacy system users and 50 percent of private-sector users of the same commercial system as DOD. In April 2023, VA announced that it planned to halt future deployments of the new EHR system to prioritize making improvements at the five sites currently using the system.
The GAO report suggested that 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 and ensure that the system demonstrates improvement toward meeting those targets.
Regarding the joint VA-DOD deployment at the Federal Health Care Center in Illinois, the GAO also highlighted work to be done. “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,” the report said. “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.”
The GAO report also noted that DOD's Program Executive Office 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.
