Sunday, October 17, 2010

GAO Publishes Report

After obligating $2 billion over 13 years to acquire an EHR system, so far, DOD has delivered capabilities for outpatient and dental care documentation but scaled back on other capabilities. In addition, users continue to experience significant problems such as speed, usability, and availability in deployed portions of the system. DOD plans to acquire a new EHR system and is working to have the “Armed Forces Health Longitudinal Technology Application” (AHLTA) system operate as a bridge to the new EHR system.

GAO just published the report “Information Technology: Opportunities Exist to Improve Management of DOD’s EHR Initiative” that looks at the status of AHLTA, determines DOD’s plans for acquiring a new system, and evaluates DOD’s acquisition management of the system.

According to the report, DOD”s new EHR system to be known as “EHR Way Ahead” is to be a comprehensive, real-time health record for service members, families, and beneficiaries to use. The system is expected to address performance problems, provide unaddressed capabilities such as comprehensive medical documentation, be able to capture and share medical data electronically within DOD, and improve existing information sharing with the Department of Veterans Affairs.

As of September 2010, the department has established a planning office to analyze alternatives for meeting the new system requirements. Completion of this project is expected in December 2010. Following completion, DOD expects to select a technical solution for the system and release a delivery schedule. DOD’s FY 2011 budget request includes $302 million for the EHR initiative.

The Military Health System (MHS) Chief Information Officer (CIO) has the primary responsibility for overseeing the acquisition, development, testing, and deployment of AHLTA. Key offices within the Office of the MHS CIO perform information management and information technology functions to support AHLTA. The Joint Medical Information Systems Office is responsible for testing, implementing, training, fielding of system components, operations, maintenance, and the ultimate disposal of system components.

To acquire the present EHR system, DOD used several contractors and different types of contracts that included fixed-price, time-and-material, and cost-plus-fixed-fee contracts. The prime developer and lead integrator for CHCS II, Integic (acquired by Northrop Grumman in 2005), was awarded a time-and-materials contract for $65.4 million in 1997.

DOD also used noncompetitive contracts to develop the system. According to the program office, eleven noncompetitive contracts and task or delivery orders, totaling $44.6 million were awarded from FY 2004 through FY 2012. Program official stated that the noncompetitive contracts were awarded since DOD’s need for the supplies and services was so urgent.

The GAO report makes several recommendations for the MHS CIO to:

• Develop and maintain a comprehensive project plan to include the project’s scope, cost, schedule, risks, and then update the plan to provide key information for stakeholders on the project’s plans and status
• Develop a systems engineering plan to address the technical complexities involved in delivering a worldwide EHR
• Make sure that the requirements development process involves system users throughout the development
• Establish bidirectional traceability for all system requirements
• Prioritize improvement projects, resources, include schedules for improvement efforts including a user feedback survey, and use the information to link measurable outcomes and specific user needs
• Include identifying milestones and a completion date for the external evaluation

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