The first stage of a multibillion-dollar military-VA digital health program championed by Jared Kushner has been riddled with problems so severe they could have led to patient deaths, according to a report obtained by POLITICO.
The April 30
report expands upon the findings of a March POLITICO story in which doctors and IT specialists expressed alarm about the software system, describing how clinicians at one of four pilot centers, Naval Station Bremerton, quit because they were terrified they might hurt patients, or even kill them
Experts who saw the Pentagon evaluation — it lists 156 “critical” or “severe” incident reports with the potential to result in patient deaths — characterized it as “devastating.”
“Traditionally, if you have more than five [incident reports] at that high a level, the program has significant issues,” a member of the testing team told POLITICO.
The project’s price tag and political sensitivity — it was designed to address nagging problems with military and veteran health care at a cost of about $20 billion over the next decade — means it is “just another ‘too big to fail’ program," the tester said.
“The end result everyone is familiar with — years and years of delays and many billions spent trying to fix the mess.”
The unclassified findings could further delay a related VA contract with Cerner Corp., the digital health records company that began installing the military’s system in February 2017. The VA last year chose Cerner as its vendor, with the belief that sharing the same system would facilitate the exchange of health records when troops left the service.
The military program, called MHS Genesis, was approved in 2015 under President Obama.
In a briefing with reporters late Friday, Pentagon officials said they had made many improvements to the pilot at four bases in the Pacific Northwest since the study team ended its review in November.
"MHS Genesis is extremely important and it is important to get MHS Genesis right," said Vice Adm. Raquel Bono, chief of the Defense Health Agency. "Feedback from the test community and dedicated professionals at the sites has been invaluable."
A White House spokesman noted Friday afternoon that Kushner had no involvement with DOD’s contract with Cerner. He did advise VA officials last year to contract with Cerner because the military was already using the vendor, and he argued the creation of a seamless, unified system would allow records to be shared between military and VA treatment centers.
"He still believes that the decision to move the VA to Cerner was the right one," the spokesman said, but noted that Kushner has advocated for “moving slowly, methodically and properly” with the VA contract to avoid the problems experienced by the military hospitals.
POLITICO reported last month that the VA contract has been delayed by
concerns expressed by close friends of the president, including Marvel Entertainment chairman Ike Perlmutter, who has advised the president on veterans’ issues, and West Palm Beach doctor Dr. Bruce Moskowitz, who got White House approval to participate in the discussions.
VA officials on Wednesday said they will decide whether to go ahead with their deal by Memorial Day. To date, indications are they plan to sign it.
Doctors and IT specialists working at the pilot sites break into two groups, according to another well-placed source: those who think there is a path to make the system work — although it will take at least a year — and those who think there is no hope for it.
Two Cerner employees who spoke to POLITICO said the Pentagon and the lead partner on the military contract, Leidos Health, were to blame for many of the early problems. Cerner, not Leidos, would be the lead contractor for the VA contract.
The Pentagon report concluded that the new software system, called MHS Genesis, is “neither operationally effective, nor operationally suitable” -- and recommended freezing the rollout indefinitely until it can be fixed.
In another alarming finding, it disclosed “two indications that MHS Genesis may not be scalable,” meaning it may be impossible to build it out through the entire military health system, which encompasses 650 hospitals and clinics serving 9.6 million troops and their beneficiaries around the world.
Testers noticed that each time a new hospital went live, the earlier sites suffered software slowdowns.
In addition, the “drop-down” selection lists in the computer program contained options from all four treatment facilities where it was rolled out. For example, users need to search through a list of every provider in the entire system to schedule a patient appointment. “Without narrowing the lists or providing a standardized structure, these lists will become unmanageable as more sites use MHS Genesis,” the report says.
Doctors and IT officials involved in the project complained to POLITICO of dangerous errors and a reduction in the number of patients they can treat because of the clumsy system. Four physicians at Naval Station Bremerton, in the Puget Sound, the first hospital to go online, described a stressful atmosphere in which prescription requests came out wrong at the pharmacy, referrals failed to go through to specialists, and tasks as basic as requesting lab work were impossible.
The Pentagon evaluation, mostly done last fall, went so badly that the testing team stopped after visiting three of the four sites so the military could fix the problems, the report says. The fourth and largest site, at Madigan Army Medical Center near Tacoma, Wash., was to be examined later this year.
Officials from Cerner and Leidos Health on Friday's call dismissed suggestions that the project could not work on a military-wide scale. They said the implementation problems were nothing they had not encountered in major commercial IT projects, and that they were being fixed. They and defense officials said the rollout is still on track to be finished in 2022.
As evidence that conditions have improved since the inspection report, patient visits increased by 20 percent from November to March, and 78 percent more prescriptions were filled on an average day, said Col. Michael Place, commander of Madigan Army Medical Center, the largest of the four installations.
"As [an initial MHS Genesis site], one of our roles is to find all those things that need to be fixed," Place said. "We take perverse pride in reporting all those things."
But former VA and military IT officials, and two investigators who saw the report, were skeptical.
“The language they use in this report is blunt,” said a source with experience examining military contracts. “And I think it was written with the purpose of being damning -- to convey the extent of the problems and to caution about moving forward.”
“You’ll continue to hear that they just made significant updates to the system, and that no one is saying to pull the plug on the program,” said the tester, who said he would be fired if his identity were released. “If DoD members, including all the healthcare professionals at those sites were actually able to freely speak, you would hear most of them calling for something else.”
Defense officials have said privately that they intend to strengthen the hardware infrastructure at their West Coast bases before moving further with the contract. The VA, meanwhile, is tentatively planning to deploy its new Cerner record system in Washington and Oregon next year, linking it to the military’s pilot implementation.
That effort could be imperiled if the military fails to improve its system beforehand, a congressional source said. “For now, there’s nothing to build on.”