Coast Guard Health Records: Timely Acquisition of New System Is Critical to Overcoming Challenges with Paper Process
Highlights
What GAO Found
Financial, technical, schedule, and personnel risks led to the United States Coast Guard's (Coast Guard) decision to terminate the Integrated Health Information System (IHiS) project in 2015. According to the Coast Guard (a military service within the Department of Homeland Security), as of August 2017, $59.9 million was spent on the project over nearly 7 years and no equipment or software could be reused for future efforts. In addition, the Coast Guard could not fully demonstrate the project management actions taken for IHiS, lacked governance mechanisms, and did not document lessons learned for the failed project.
As a result of the cancelation of the IHiS project and the decommissioning of the two legacy electronic health record (EHR) systems IHiS was to replace, the Coast Guard directed its clinics to revert to maintaining health records using a predominantly paper process. Coast Guard Regional Managers and clinic and sick bay administrators informed GAO of the many challenges encountered in returning to a paper process. These challenges include the inability for some clinics to adequately track vital information such as the medications members are taking—potentially causing harm to them.
Top Four Challenges Reported by Clinic and Sick Bay Administrators in Managing Paper Heath Records
To help alleviate several of these challenges, the Coast Guard has developed alternative work-around processes. However, these alternative processes may not provide sustained solutions to overcoming these challenges.
In February 2016, the Coast Guard initiated the process for acquiring a new EHR system. As of November 2017, agency officials had conducted research and recommended a solution based on performance, risk, cost, and schedule advantages. However, 2 years after canceling IHiS and moving toward a predominately manual process, the agency has not yet made a final determination on this. Successfully and quickly implementing an EHR system is vital to overcoming the challenges Coast Guard currently faces in managing paper health records. The expeditious implementation of such a system can significantly improve the quality and efficiency of care to the thousands of Coast Guard active duty and reserve members that receive health care.
Why GAO Did This Study
In 2010, the Coast Guard initiated an effort—known as IHiS—to replace its aging EHR system with a suite of modernized systems that was to automate various health care services for its nearly 50,000 military members. However, in October 2015, the Coast Guard announced that the modernization project would be canceled.
GAO was asked to review the Coast Guard's efforts to develop a modernized EHR system. GAO's objectives were to (1) describe what led the Coast Guard to terminate further IHiS development, and how much was spent on the project; (2) evaluate the Coast Guard's management and oversight for the discontinued project and what, if any, lessons learned were identified; (3) describe the Coast Guard's current process for managing health records and the challenges, if any, it is encountering; and (4) determine the Coast Guard's plans for effectively implementing a new EHR system and the current status of its efforts. To do so, GAO reviewed project expenditures, analyzed key project management documentation, surveyed Regional Managers and clinical staff, and interviewed knowledgeable staff.
Recommendations
GAO is recommending the Coast Guard (1) expeditiously and judiciously pursue the acquisition of a new EHR system, and in doing so (2) ensure key processes are implemented, (3) establish project governance boards, and (4) document lessons learned. The Department of Homeland Security concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| United States Coast Guard |
Priority Rec.
The Commandant should direct the Chief Information Officer and the Chief Acquisition Officer to expeditiously and judiciously pursue the acquisition of a new EHR system. (Recommendation 1) |
The Coast Guard stated that they are judiciously pursuing an electronic health record solution through its acquisition process. In February 2020, we verified that Coast Guard had taken steps to expeditiously and judiciously implement an EHR system by following their established systems development processes and documenting key artifacts to demonstrate their efforts. While the Coast Guard has yet to implement the EHR system, we believe they have met the intent of the recommendation by continuing to work toward implementation.
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| United States Coast Guard | The Commandant should direct the Chief Information Officer and the Chief Acquisition Officer to ensure established processes required for the future acquisition or development of an EHR are effectively implemented and adequately documented. (Recommendation 2) |
In February 2020, we verified that the Coast Guard had taken steps to implement its established systems development processes and document the required artifacts related to key steps in the process for Segment A and Segment B of the EHR project.
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| United States Coast Guard | The Commandant should direct the Chief Information Officer and the Chief Acquisition Officer to establish and fully implement project governance boards for the future EHR effort that include the Chief Information Officer. (Recommendation 3) |
The Coast Guard established the Executive Oversight Council (EOC) in order to provide oversight of acquisition programs. The EOC includes the Chief Information Officer and the Chief Acquisition Officer. In April and September 2019, Coast Guard officials provided EOC meeting minutes that demonstrated that the EOC had been implemented and that a representative from the Office of the Chief Information Officer attended the meetings.
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| United States Coast Guard | The Commandant should direct the Chief Information Officer and the Chief Acquisition Officer to document any lessons learned from the discontinued IHiS project, share them with the new project management team, and ensure lessons learned are utilized for the future EHR effort. (Recommendation 4) |
In April and October 2018, Coast Guard provided three lessons learned from the IHiS project, including that IT investments at Coast Guard need adequate program/project management and governance oversight. Officials shared these lessons learned with the new project management team and have taken steps to ensure they are utilized for the eHRa effort. For example, to help ensure that the eHRa project receives adequate management and governance oversight, Coast Guard has taken steps to provide the eHRa project manager with the appropriate project management certifications, and has established a data sharing agreement with the Department of Defense, among other things.
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