The Department of Defense's electronic health record project failed to deliver after over $2 billion and 13 years of effort. Poor planning, requirements gathering, and lack of buy-in from end users led to significant delays and an unusable system. When finally deployed in 2009, it received overwhelmingly negative feedback from medical providers due to its slowness, difficulty to use, and unreliability.

1. 2nd
THE DEPARTMENT OF DEFENSE’S FAILED
PROJECT
ELECTRONIC HEALTH RECORD
DATE BY
26 FEB 2013 MARK SILVERBERG

2. Project Overview
HISTORY COMPONENTS
1988 - DOD begins to acquire an EHR client-server architecture
(“Composite Health Care System”) client-side apps
1993 - deployed but lacked many server software/hardware
features like integration b/w systems clinical data repository
and did not use data standards
“perpetuated the reliance on paper- DELIVERY
based record” Like CHCS I, development and
implementation contracted out
1997 - new project (CHCS II) with 26 competitive RFPs which
nearly identical scope as 1988 but w/ resulted in contracts for T&M & FFP
emphasis on worldwide, 24/7 access, 11 non-competitive contracts
common data standards later found to be unnecessary
by FAR guidelines
KEY INPUTS 2009 - deployment with overwhelming
requirements were first of many negative feedback
problems; delayed multiple times “Intolerable” - congress hearing
=> delay in creating WBS “slow, difficult to use, unreliable”
“EHR Way Ahead” = CHCS III

3. Challenges
POOR 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 GATHERING
Essential to establishing and controlling scope
End 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 USERS
Army’s Surgeon General “faced a near mutiny of our healthcare
providers, our doctors, our nurse practitioners, physician assistants”
USAF Deputy Surgeon General: “low productivity and provider
morale [from] working around the system trying to find new solutions”
GAO: “[DOD] stopped measuring user satisfaction levels in July 2007
after overall user satisfaction had declined to its lowest point
in more than 2 years.”

4. What Project Management?
Costs were neither minimized nor benefits maximized (or in many cases realized)
$2 BILLION OVER 13 YEARS