Last year, staff at Kirk Army Health Clinic in Aberdeen Proving Ground, MD, received on-site support from individuals identified as MHS GENESIS Super Users during the launch of MHS Genesis in March. The new electronic health record for the Military Health System integrates inpatient and outpatient electronic health records across the continuum of care from the point of injury to the MTF. Army photo from Kirk Army Health Clinic
WASHINGTON, DC — A recent survey of employees at military treatment facilities shows significant dissatisfaction with DoD’s new electronic health record system (EHR), which completed its 7-year rollout in March. Employees are finding the system lacking compared to the legacy systems it’s replacing, as well as to the civilian version of the same EHR.
DoD has no plans for how to improve the situation, a recent Government Accountability Office (GAO) report found, however.
MHS GENESIS officially went live at its first facility in February 2017, initiating a 24-part rollout that culminated in March 2024 with its installment at the Lovell Federal Health Care Center, the joint VA/DoD facility in Chicago. The system now serves over 190,000 users at military treatment facilities worldwide.
In 2022, DoD began conducting an annual user satisfaction survey, which showed broad discontent with the GENESIS system compared to alternatives. The results of the 2023 survey are modestly improved, but still show large gaps between what leaders want GENESIS to be and the experiences of employees in the field.
Of those surveyed, only 39% are satisfied with the system’s ability to facilitate patient-centered care, compared to 56% for legacy systems and 46% for the private-sector version. Only 20% believe the system helps them improve efficiency, compared to 36% for legacy systems and 32% for the private sector. And 29% believe it allows them to deliver a high quality of care, compared to 46% for legacy and 50% for private sector.
Respondents also reported a low system response time (60%) and that the system was not always available when it was needed (34%).
GAO has documented issues throughout the rollout that might have foreshadowed the current gap between system ability and user needs. In September 2021, the watchdog reported that issues identified during system testing remained unresolved, and that employee training was ineffective.
Too Many System Changes
Users reported that the training was not consistent with what they were experiencing with the live system; that there were too many system changes to keep up with; and that they were not always informed of system changes that impacted them before they were implemented.
The plans for the Lovell FHCC rollout incorporated provisions to address this gap in training, including 135 positions to support GENESIS deployment efforts. As of March, only 71 of those positions had been filled. FHCC officials cited challenges with the long onboarding process (137 days from vacancy to full employment), as well as difficulty competing with other employers who offer better salaries and remote work.
One of the more troublesome issues with the GENESIS system has been the Dentrix dental module. Problems with the module began as early as October 2018, as the module was unable to keep up with the increased number of users.
“As of January 2024, the program office stated that the Dentrix vendor would not be able to provide an interface needed to provide critical functionality,” the GAO report stated. “The issue is still not resolved, and the impact remains severe. Until the program office identifies an alternative approach to resolving the Dentrix issue, MHS GENESIS will not provide critical functionality to dentists who are treating service members and other DOD beneficiaries.”
While DoD has established that its users are unsatisfied, the department has yet to create a plan to improve the situation.
“Officials stated that this was because the department focused its priorities on deploying the system to all sites and ensuring patient safety,” the report states. “While these are important priorities, until DOD also establishes targets (i.e., goals) for improving user satisfaction, the department will be limited in its ability to objectively measure progress, plan for improvements, and ensure that the system optimally meets the users’ needs.”
This echoes similar findings with the much rockier rollout of VA’s EHR, which is based on the same CERNER-ORACLE-designed technology. Both VA and CERNER have been heavily criticized for not incorporating user feedback earlier in the process, resulting in widespread system problems, dismal satisfaction ratings, and a long-stalled rollout.
The GAO recommended that DoD establish goals for user satisfaction ratings and make plans on how to meet them, as well as find a replacement for the Dentrix dental module.