Despite a $2 billion price tag and a 13-year buildout, the electronic health record (EHR) system implemented by the Department of Defense (DoD) has been deemed insufficient, according to a new report from the Government Accountability Office. The department has stated that it intends to acquire a new EHR system to replace its Armed Forces Health Longitudinal Technology Application (AHLTA).
The Defense department’s original EHR system, the Composite Health Care System (CHCS), was deployed in 1993 but lacked integration capabilities. Dissatisfied with CHCS, the department initiated the AHLTA project in 1997 to “address the need for a comprehensive, lifelong, computer-based health care record for every service member and their beneficiaries.”
The original AHLTA plan called for the release of four blocks of capabilities and a 2007 completion. But the best-laid schemes of mice and men often go awry: Only the first block has been fully deployed; the second block has been partially deployed, and the third and fourth blocks were terminated from the project. To make matters worse, users continue to experience problems with AHLTA’s performance.
What went wrong with AHLTA? A number of weaknesses contributed to the EHR system not being completed, the GAO report noted:
- Lack of project planning. The project plan was incomplete and not well maintained — it was last updated in 2005. “Although the department established a project management plan, it did not include several standard components, such as the project’s scope, a requirements management plan, cost estimates and baseline, a schedule, and a staffing management plan,” the report noted.
- Lack of systems engineering. The DoD did not develop a systems engineering plan to help address the complex technical aspects of the project.
- Ineffective requirements process. End users were not adequately involved throughout the requirements development process, and the result was a system with usability issues.
- Lack of planning to address usability problems. Efforts to improve user satisfaction with the system were ad hoc and unsuccessful.
The DoD intends to stabilize and improve AHLTA through 2015, but it is also has plans to pursue another EHR system, named EHR Way Ahead (EHRWA). It established a planning office for the project in September 2010 to begin analyzing alternatives for meeting the new system’s requirements. Following completion of the analysis — scheduled for December 2010 — the department expects to select a technical solution and release a delivery schedule. The DoD budget for 2011 includes a request for $302 million to support EHRWA.
The GAO strongly advised the DoD to address the weaknesses that have plagued the AHLTA project. Its report concluded, “It is imperative that the department take immediate steps to improve its management of the initiative. Until it does so, it risks a continuation of the problems it has already experienced, which could again prevent DoD from delivering a comprehensive health record system for serving its service members and their families.”