The Coast Guard Attributed IHiS Termination to Financial and Other Risks, after Spending Approximately $60 Million on the Project

According to the Director of HSWL, who was appointed to the position in  August 2015, financial, technical, schedule, and personnel risks led the  Coast Guard’s EOC to decide to terminate the IHiS project. Further, according to Office of  Budget and Programs staff members, no equipment or software from the  IHiS project could be reused for future efforts. The Coast Guard Could Not Demonstrate Effective Project Management, Lacked Governance Mechanisms, and Did Not Document Lessons Learned for the IHiS Project

The Coast Guard could not demonstrate that it effectively managed and  oversaw the IHiS project prior to its discontinuance. The Coast Guard Is Managing Health Records Using a Predominately Paper Process; Many Challenges Hinder Service Delivery

In the absence of an EHR system, the Coast Guard currently relies on a  predominately paper health record management process to document  health care services for its nearly 50,000 military members. After  canceling the IHiS project in October 2015, the agency could not return to  managing health records using its legacy electronic capabilities because  PGUI was decommissioned in 2015 and CHCS was decommissioned in  January 2016. Tracking medications. However, these alternative processes may not  provide sustained solutions to overcoming these challenges. The Coast Guard Intends to Acquire a New EHR System, but Has Not Yet Chosen a Solution

The Coast Guard has begun taking steps to acquire a new EHR system  referred to as the Electronic Health Record Acquisition (eHRa). The  report recommended a solution based on performance, risk, cost, and  schedule advantages. As of December 2017, the Coast Guard had not yet made a final  determination as to which option would be chosen as the solution for the  eHRa acquisition. Specifically, the Coast Guard could not fully show key  project management actions were taken for IHiS, lacked governance  mechanisms, and did not document lessons learned for the failed project. To help  alleviate several of these challenges, the Coast Guard’s clinics and sick  bays have developed alternative work-around processes. Successfully and quickly  implementing an EHR system is vital to overcoming the challenges the  Coast Guard currently faces in managing paper health records. The  expeditious and judicious implementation of such a system can  significantly improve the quality and efficiency of care to the thousands of  Coast Guard active duty and reserve members that receive health care. (Recommendation 4)

	Agency Comments and Our Evaluation

The Department of Homeland Security provided written comments on a  draft of this report. Appendix I: Objectives, Scope, and Methodology

The objectives of this study were to (1) describe what led the United  States Coast Guard (Coast Guard) to the decision to terminate further  Integrated Health Information System (IHiS) development, and how much  was spent on the project; (2) evaluate the Coast Guard’s management  and oversight actions for the discontinued electronic health records (EHR)  modernization project and what, if any, lessons learned were identified;  (3) describe the Coast Guard’s current process for managing health  records and the challenges, if any, it is encountering; and (4) determine  the Coast Guard’s plans for effectively implementing a new EHR system  and the current status of its efforts.
Why GAO Did This Study

In 2010, the Coast Guard initiated an effort—known as IHiS—to replace its aging EHR system with a suite of modernized systems that was to automate various health care services for its nearly 50,000 military members. However, in October 2015, the Coast Guard announced that the modernization project would be canceled.
GAO was asked to review the Coast Guard's efforts to develop a modernized EHR system. GAO's objectives were to (1) describe what led the Coast Guard to terminate further IHiS development, and how much was spent on the project; (2) evaluate the Coast Guard's management and oversight for the discontinued project and what, if any, lessons learned were identified; (3) describe the Coast Guard's current process for managing health records and the challenges, if any, it is encountering; and (4) determine the Coast Guard's plans for effectively implementing a new EHR system and the current status of its efforts. To do so, GAO reviewed project expenditures, analyzed key project management documentation, surveyed Regional Managers and clinical staff, and interviewed knowledgeable staff.

What GAO Found

Financial, technical, schedule, and personnel risks led to the United States Coast Guard's (Coast Guard) decision to terminate the Integrated Health Information System (IHiS) project in 2015. According to the Coast Guard (a military service within the Department of Homeland Security), as of August 2017, $59.9 million was spent on the project over nearly 7 years and no equipment or software could be reused for future efforts. In addition, the Coast Guard could not fully demonstrate the project management actions taken for IHiS, lacked governance mechanisms, and did not document lessons learned for the failed project.
As a result of the cancelation of the IHiS project and the decommissioning of the two legacy electronic health record (EHR) systems IHiS was to replace, the Coast Guard directed its clinics to revert to maintaining health records using a predominantly paper process. Coast Guard Regional Managers and clinic and sick bay administrators informed GAO of the many challenges encountered in returning to a paper process. These challenges include the inability for some clinics to adequately track vital information such as the medications members are taking—potentially causing harm to them.
To help alleviate several of these challenges, the Coast Guard has developed alternative work-around processes. However, these alternative processes may not provide sustained solutions to overcoming these challenges.
In February 2016, the Coast Guard initiated the process for acquiring a new EHR system. As of November 2017, agency officials had conducted research and recommended a solution based on performance, risk, cost, and schedule advantages. However, 2 years after canceling IHiS and moving toward a predominately manual process, the agency has not yet made a final determination on this. Successfully and quickly implementing an EHR system is vital to overcoming the challenges Coast Guard currently faces in managing paper health records. The expeditious implementation of such a system can significantly improve the quality and efficiency of care to the thousands of Coast Guard active duty and reserve members that receive health care.

What GAO Recommends

GAO is recommending the Coast Guard (1) expeditiously and judiciously pursue the acquisition of a new EHR system, and in doing so (2) ensure key processes are implemented, (3) establish project governance boards, and (4) document lessons learned. The Department of Homeland Security concurred with GAO's recommendations.