PROJECT

DATE BY26 FEB 2013 MARK SILVERBERGELECTRONIC HEALTH RECORDTHE DEPARTMENT OF DEFENSE’S FAILED

2nd

Project OverviewHISTORY

1988 - DOD begins to acquire an EHR (“Composite Health Care System”)1993 - deployed but lacked many features like integration b/w systems and did not use data standards“perpetuated the reliance on paper-based record”

1997 - new project (CHCS II) with nearly identical scope as 1988 but w/ emphasis on worldwide, 24/7 access, common data standards

KEY INPUTSrequirements were first of many problems; delayed multiple times => delay in creating WBS

COMPONENTSclient-server architecture

client-side appsserver software/hardwareclinical data repository

DELIVERYLike CHCS I, development and implementation contracted out

26 competitive RFPs which resulted in contracts for T&M & FFP11 non-competitive contracts

later found to be unnecessaryby FAR guidelines

2009 - deployment with overwhelming negative feedback

“Intolerable” - congress hearing“slow, difficult to use, unreliable”

“EHR Way Ahead” = CHCS III

ChallengesPOOR PROJECT PLANNING

“comprehensive project management plan was not established” - GAO“poor planning and execution and a failure to appreciate the ‘significant complexity’ of the program” - health industry analyst

REQUIREMENTS GATHERINGEssential to establishing and controlling scopeEnd users of the system were only engaged at the beginning and end of the project lifecycle so when they did provide feedback at the end, it was too late to inform development

LACK OF BUY-IN AND NO FEEDBACK LOOP WITH USERSArmy’s Surgeon General “faced a near mutiny of our healthcareproviders, our doctors, our nurse practitioners, physician assistants”USAF Deputy Surgeon General: “low productivity and providermorale [from] working around the system trying to find new solutions”GAO: “[DOD] stopped measuring user satisfaction levels in July 2007after overall user satisfaction had declined to its lowest pointin more than 2 years.”

What Project Management?Costs were neither minimized nor benefits maximized (or in many cases realized)

$2 BILLION OVER 13 YEARS