Madigan Army Medical Center focusing on security, patient safety before Cerner rollout
Cerner will launch its fourth and final electronic health record pilot with the U.S. Department of Defense at the Madigan Army Medical Center on Oct. 21.
The rollout of MHS Genesis at Madigan is the largest undertaking of the pilot, as it’s one of the biggest military hospitals on the West Coast. DoD, Cerner and Leidos Partnership for Defense Health have already launched at Fairchild Air Force Base, Naval Hospital Oak Harbor and Naval Hospital Bremerton.
The Department of Veterans Affairs will likely be looking to this pilot for lessons, as it moves closer to securing its contract with Cerner for its own replacement of its legacy EHR Vista.
DoD, much like the VA, was an early adopter of electronic systems. But the agency’s ALTHA had disparate systems that couldn’t speak to each other and were expensive to maintain. Madigan employees -- like those from other DoD facilities -- have long grown tired with the outdated, legacy system.
“Most doctors want change tomorrow,” said Col. Eric Shry, MD, chief medical informatics officer at Madigan Army Medical Center. “There’s a huge amount of excitement by all the clinicians and staff.”
Preparation for the rollout began three years ago, although the DoD has been using EHRs for more than 35 years, said Shry.
“We approached this like a military mission,” said Shry. “There was a substantial amount of work required to standardize workflows between Army, Navy and Air Force, with over 700 workflow advisory groups creating the workflows that informed the enterprise build.”
While the medical center’s rollout plan reads like most civilian hospitals -- with training, technical and communications teams -- Madigan had one major difference. It used a military operations cell to connect 5,000 people spread out over hundreds of facilities and 60 miles.
Shry’s team focused on providing military orders coming from the commander to streamline incoming, necessary information about timing and activities related to the rollout.
“This allowed us to execute at a scale with reliability that would be impossible in civilian organizations,” said Shry.
But one crucial component is true to all providers attempting a major tech rollout: clinical informatics.
Madigan has one of the largest clinical informatics divisions in the DoD and the only DoD physician informatics fellowship program, which Shry said allowed his time to better plan, create and execute the necessary military orders.
Safety is paramount to the rollout, and the hospital is leaning on the support and experience from Leidos and Cerner to execute plans that will keep patients safe. Along with a Remedy ticket tracking system that includes 80 tags to be aggregated in real-time, Madigan will also implement adoption measures that will be constantly monitored.
“We have a detailed local and enterprise governance process in place to handle issues rapidly,” said Shry.
Security is top-of-mind
The biggest challenge of the Cerner pilot, much like all other DoD processes, is cybersecurity. The DoD poses some interesting safety complications, when you consider a shared environment where both combat drones and medical records exist in the same space.
“Daily massive threat of attack is our reality,” said Shry. “Our safety requirements are much, much, much higher than any organization in the world.”
Like most private sector organizations, one of Shry’s biggest safety concerns is medical devices. Medical device vendors have far “too long thought of security as an afterthought and doing any updates after FDA approval is seen as a cost, not an opportunity to improve patient (data) safety.”
“Vendors see outsourcing IT support to countries that are not our friends as a way to cut costs rather than a security risk,” he added. “We will not compromise our security or patient safety.”
As a result, the team at Madigan is leveraging significant resources to ensure the DoD has one of the most secure health IT systems in the world. And as the rollout date draws closer, Shry is working to overcome potential technical challenges -- like cybersecurity and network -- to ensure the system is secure.
Leidos and Cerner’s proven track record of success gives Shry some piece of mind, but said he is focusing more on potential issues as “implementing this proven system involves unique challenges.”
Overcoming workflow/platform challenges
One overall concern for Madigan is ensuring the transition from a legacy, government system to an EHR modeled on private sector needs is seamless.
“Higher level DoD concerns during transition are primarily not about care delivery but about changes in work process and data unification,” Shry said.
Included in Madigan’s system are more than 40 years of measures that are used to report to Congress and other agencies, which Shry is worried may not easily map to civilian EHRs. But the plan is to lean on a seven-year transition process.
Further, Shry and his team are using the Joint Legacy Viewer -- a clinical app that provides an integrated readout of health data across the VA and DoD -- to be able to view archived clinical data. But the real challenge will be comparing administrative and business performance from both legacy and modern EHRs.
“Civilian capabilities, like block appointments, do not fit neatly into the DoD access measures,” said Shry. “Patient activity-based accounting offers a significant challenge to work center and facility accounting that we have become accustomed to over decades.
“Adopting civilian norms will be difficult in the near term, but tremendously beneficial in the long term,” he added.