DOD's EHR Failure Due to Poor Planning, Says GAO

Shortcomings in the Department of Defense's failed 13-year, $2 billion transition to electronic medical records were largely due to poor planning and execution, and a failure to appreciate the "significant complexity" of the program, the Government Accountability Office said.

DOD's EHR project—the Armed Forces Health Longitudinal Technology Application (AHLTA)—was expected to give the military's healthcare providers realtime access to health information for the 9.6 million active duty service members, their dependents, and other beneficiaries worldwide. However, the system hasn't met expectations.

GAO was asked by DOD to examine AHLTA's shortcomings as the military prepares to acquire a replacement system called EHR Way Ahead, for which the federal government has budgeted $302 million in fiscal 2011.

GAO found that AHLTA had met some benchmarks for outpatient care and dental care documentation, but that DOD had been forced to scale back other capabilities. "In addition, users continued to experience significant problems with the performance (speed, usability, and availability) of the portions of the system that have been deployed," GAO reported.

DOD has begun to improve system performance and enhance functionality and plans to continue to stabilize the AHLTA system through 2015, as a "bridge" to EHR Way Ahead. "However, it has not carried out a planned independent evaluation to ensure it has made these improvements. Until it ensures that these weaknesses are addressed, DOD risks undermining the success of further efforts to acquire EHR capabilities," GAO reported.

Weaknesses in acquisition management and planning processes contributed to AHLTA's persistent underperformance. GAO identified four problem areas:

• A project management plan was not established to guide DOD's execution of the system acquisition.
• A systems engineering plan did not exist to guide the "significant complexity" of the technical development.
• Requirements were incomplete and did not reflect user and operational needs.
• There was no plan to improve users' satisfaction.

EHR Way Ahead 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.

DOD said it is acting on all of the GAO recommendations. 

See also:

5 EHR Myths, Busted