Thirteen years, $2 billion and one program name change later after the Defense Department initiated its second attempt to create an electronic health record system, military doctors are still dissatisfied, reports the Government Accountability Office.

The DoD plans to try yet again with a new system known as EHR Way Ahead, requesting $302 million for a new system in the fiscal 2011 budget request. It is conducting an analysis of alternatives that is scheduled for completion by December 2010.

The current system, first known as Composite Health Care System II but renamed in November 2005 to the Armed Forces Health Longitudinal Technology application (AHLTA), has been plagued by server outages and a poor user experience, according to the GAO report.

Attempts to fix AHLTA in some cases may have made things worse, as demonstrated by an attempt to solve the server outage problem. AHLTA is a three-tier system and engineers attempted to place local cache servers so doctors could continue to draw on patient data when the central data repository went down. However, after installing local servers, AHLTA engineers realized that they instead had created a single point of failure.

"Rather than yield operational improvements, department officials acknowledged that these actions resulted in additional challenges, including the need for a costly local cache server redesign, which was begun in fiscal year 2009," the report states. As of April 2010, clinicians have continued to complain about server outages, the report adds.

AHLTA development did not follow many best practices, including keeping its project management plan current or adequately involving users in requirements development, auditors state. Many clinicians prefer not to use AHLTA while actually seeing a patient since entering information during a patient encounter would take attention away from the patient for an unacceptable amount of time.

Developers told auditors they've attempted to improve user satisfaction, but the GAO couldn't find evidence of a plan that prioritized improvements or associated improvements with resource requirements and schedules. Ad hoc attempts to improve AHLTA "did not meet with success," the report states. In fact, the program office stopped measuring AHLTA user satisfaction in July 2007 after it declined to its lowest point in more than two years, the report states.

For more:
- download the report, GAO-11-50 (.pdf)

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