Recently Released GAO Report Indicates Progress and Challenges Implementing MHS Genesis

Published: September 22, 2021

Federal Market AnalysisDHAElectronic Health RecordHealth IT

According to GAO, as of the end of June 2021, DOD had deployed its new Electronic Health Record (EHR) system, MHS Genesis, to six of 24 planned sites. Although DOD addressed initial issues and improved system performance at the sites, challenges remain in the areas of testing, training and communication with system users.

GAO conducted this audit to determine DOD’s progress in implementing the new EHR solution, which is based on Cerner’s Millennium system, and to identify any risks and deployment challenges the agency might face. To conduct its analysis, GAO reviewed test reports, briefing materials, and incident report tracking documents. It also held discussions with 356 users at selected sites and interviewed relevant officials. 

The report publically released by GAO on Monday provides documentation of a briefing the agency held with Congressional staff in April 2021.  GAO also submitted the public report directly to House and Senate appropriations committees on Monday. GAO updated data and content covered by the report to include the period after the initial briefing in April. The entire audit now covers from August 2018 to September 2021.

As of the end of June 2021, deployment of MHS Genesis was complete at the following six sites or waves, with the accompanying number of users:

  • Madigan (Initial Operating Capability – IOC) – 3,400 users
  • Travis – 4,700 users
  • Nellis – 3,500 users
  • Pendleton – 5,300 users
  • San Diego – 9,000 users
  • Carson – 15,700 users

To date, DOD has 41,600 users on the new system out of 201,400 planned users. DOD’s MHS Genesis program office plans to deploy the system to users at the remaining 18 sites/waves at a pace that is more than five times faster than the pace of deployments that have previously been undertaken. Complete deployment to the remaining 159,800 users is planned by the end of December 2023.

GAO found that during initial and follow-on operational testing of MHS GENESIS, the Joint Interoperability Test Command (JTIC) identified 710 incidents, of which 409 were closed as of February 2021. Later review revealed an additional 13 test incidents were closed, leaving a total of 288 incidents unresolved as of May 2021. Sixty one of these incidents are classified as “Critical” and 81 are classified as “Major.”

Although DOD made progress toward resolving testing incidents, according to GAO, the department did not develop plans to conduct additional testing at future sites. GAO believes that without additional testing, DOD cannot ensure incidents will be fully resolved. This could lead to system deployment challenges at future wave sites.

GAO also found that the implementation of MHS GENESIS lacked real-life training and communication regarding system changes. During GAO’s discussions with system users, it discovered that prior system training did not match the “live” system. Additionally, users reported that system changes occurred very frequently and they were not consistently informed in advance. GAO reported, “As a result, users were unaware of important changes to their roles or business processes, or to system revisions and improvements.”

GAO recommends DOD take the following actions to improve MHS Genesis deployment:

  • Develop an approach for retesting the incidents identified to ensure they have been resolved.
  • Improve the effectiveness of MHS GENESIS training by ensuring it is relevant to user roles.
  • Ensure users are aware of system changes and monitor users’ awareness of changes.

DOD concurred with GAO’s recommendations.