Coast Guard EHR Acquisition: Round Two

The Coast Guard is a military service within the Department of Homeland Security which is responsible for maritime safety, security, and environmental stewardship in U.S. ports and waterways. It also acts as a first responder and a law enforcement agency for maritime transportation. To support its mission areas, the Coast Guard is tasked with providing health care to active duty and reserve members, ensuring the medical and dental readiness of Coast Guard members, and ensuring the availability of quality, cost-effective health care for eligible beneficiaries. Historically, the Coast Guard has used EHR systems to schedule patient appointments, document patient consults and referrals, and track prescribed medications.

GAO was asked to review the Coast Guard’s efforts to implement a modernized EHR system, examine the circumstances that led to cancelation of the previous EHR implementation program, and evaluate management oversight for the discontinued program.  

GAO found that the Coast Guard implemented DOD’s Composite Health Care System (CHCS) and its Provider Graphical User Interface (PGUI) during 2002 to 2004, but the systems did not provide all the needed capabilities.  The Coast Guard looked at implementing DOD’s Armed Forces Health Longitudinal Technology Application (AHLTA), but determined it was too costly and didn’t provide needed functionality.  So it made the decision to purchase a COTS EHR, and awarded a 5 year, $14M contract to Epic in Sept 2010. The system was to provide ambulatory services; online management of patient health records; patient scheduling and billing services; dental and radiology modules; management of prescribed medications; and track laboratory orders.

While working to implement the Epic system, the Coast Guard staff found that many other Coast Guard health care-related IT systems were outdated and also needed modernization. The initial project was expanded to include these other systems and was renamed the Integrated Health Information System (IHiS).  The project ballooned to various contracts with 25 different vendors and costs in excess of $60M when the decision was made to end it in October of 2015.  The Coast Guard decommissioned PGUI in 2015 and CHCS in 2016 which forced the Coast Guard to implement a paper-based health record system which it is still in operation to date.

According to the Coast Guard Director of Health, Safety and Work Life Directorate (HSWL) which oversaw implementation and then discontinuance of the EHR effort, financial, technical, schedule, and personnel risks led to the decision to terminate the IHiS project. GAO’s research also found that the Coast Guard lacked governance mechanisms for the project and did not document lessons learned.

In the absence of an EHR system, the Coast Guard currently relies on a predominately paper health record management process to document health care services for its nearly 50,000 military members. The paper process has created challenges, including the inability for some clinics to adequately track vital information such as member medications.

In April 2017, the Coast Guard put out an RFI to solicit information from industry regarding EHR solutions, calling the new initiative the Electronic Health Record Acquisition (eHRa).  But to date, the Coast Guard has not moved forward with an acquisition.  GAO believes timely acquisition of a new system is critical to overcoming challenges with the paper process.

Rear Adm. Michael Haycock, the Coast Guard’s chief acquisition officer, testified that moving to DOD’s MHS Genesis solution is one of the “preferred alternatives” the Coast Guard is considering. He told the House Subcommittee on Coast Guard and Maritime Transportation in late January that details on Coast Guard’s path forward would be determined by the end of February.

GAO recommends the Coast Guard “expeditiously and judiciously” pursue the acquisition of a new EHR system, ensure key processes are implemented, establish project governance boards, and document lessons learned. The Coast Guard concurrs with GAO’s recommendations.