Facets of Electronic Health Record Implementation within the Department of Defense: Lessons Learned in Leadership

Introduction: The military health system (MHS) is undergoing a modernization of its electronic health record (EHR) by implementing an integrated EHR called MHS-GENESIS, a $4 billion commercially procured EHR-based on Cerner’s Millennium platform. Most literature regarding EHR transitions focuses on a single health system such as a multi-hospital network, which pales in comparison to the size, scope, and pace of the MHS’ EHR implementation. Because of this, traditional and non-traditional leadership methods are required to successfully orchestrate an EHR transition. By the end of calendar year 2023, MHS-GENESIS will be implemented in over 850 medical and dental treatment facilities worldwide. This EHR transition impacts more than 9.5 million Department of Defense (DOD) beneficiaries and over 250,000 MHS end users by integrating and optimizing the technology to streamline access to health records.

Materials and methods: The authors surveyed available literature to identify the knowledge and information about key facets of EHR implementation and transition in healthcare systems overall. This review will explore published literature and provide a comprehensive comparison between the DOD’s implementation of MHS-GENESIS and the private sector/civilian healthcare organizations’ EHR implementations. MHS-GENESIS implementations do not have robust published literature; therefore, the authors sought the DOD subject matter experts to provide information and perspective about the unpublished data and information about the EHR transition.

Results: Each MHS GENESIS go-live event is an opportunity to disseminate best practices and lessons learned to improve future integrations in military and non-military healthcare organizations. However, published literature providing a comprehensive review on MHS-GENESIS roll out and post-implementation best practices is lacking. In addition, findings of studies citing MHS-GENESIS implementation are limited in scope and rigor. Due to the magnitude and the wide geographical spread of the EHR transition across the DOD, standardization and collaboration across the military services are key to a successful MHS-GENESIS implementation. A list of challenges and sustainable lessons learned from the MHS-GENESIS Go-live at one military treatment facility (MTF) are described to potentially aid other healthcare organizations in future and successful EHR implementations while also discussing how organizations can promote and encourage clinical transformation within a positive culture of change.

Conclusion: MHS-GENESIS continues to be phase implemented and currently in the Atlantic and European regions. At the forefront of clinical transformation, clinicians at all levels drive change management across healthcare organizations. Garnering best practices and lessons learned from the military’s larger-scale EHR transition provides a model for future successful EHR implementation for any healthcare system, regardless of size or entity, and leverages the influence leadership holds in the process.