	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 Executive Oversight Council to decide to terminate the  IHiS project in October 2015:
Financial risks. In addition, over 2 years after the project’s cancelation, the  Coast Guard continued to pay vendors. Further, according to staff in Coast Guard’s Office of Budget  and Programs, 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, and did not document  and share valuable lessons learned from the failed project. The Coast Guard Is Managing Health Records Using a Predominately Paper Process, but Many Challenges Hinder Service Delivery

In the absence of an EHR system, the Coast Guard is relying on a  predominately paper health record management process to document  health care services for its nearly 50,000 military members. Currently, the  Coast Guard’s clinical staff perform various manual steps to process each  paper health record. The responding clinic and sickbay administrators described a range of  alternative work-around processes that they have developed to help  alleviate several of the challenges. 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. Implementation of Our Recommendations Should Better Position Coast Guard to Overcome Challenges with Paper Health Records

Our report that is being released today contains four recommendations to  the Coast Guard. Specifically, we recommend that the Coast Guard: expeditiously and judiciously pursue the acquisition of a new EHR ensure established processes required for the future acquisition or  development of an EHR are effectively implemented and adequately  documented; direct the Chief Information Officer and the Chief Acquisition Officer to  establish and fully implement project governance boards for the future  EHR effort that include the Chief Information Officer; and document any lessons learned from the discontinued IHiS project,  share them with the new project management team, and ensure  lessons learned are utilized for the future EHR effort. The Department of Homeland Security concurred with our four  recommendations and identified actions being taken or planned to  implement them. If the Coast Guard fully and effectively implements our  recommendations, many of the challenges faced by its clinics and sick  bays and the thousands of Coast Guard members utilizing its health  services could be diminished. Until a  solution for its EHR system is chosen and successfully implemented, the  agency is likely to continue to face these challenges.
Why GAO Did This Study

In 2010, the Coast Guard initiated an effort—known as IHiS—to replace its aging EHR system with a new system that was to modernize 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 summarize its report that is being released today on the Coast Guard's actions related to its EHR modernization initiative. GAO's testimony specifically addresses Coast Guard's (1) reasons for deciding to terminate further IHiS development; (2) management and oversight actions for the discontinued project and whether lessons learned were identified; (3) current process for managing health records and the challenges it is encountering; and (4) plans for effectively implementing a new EHR system and the current status of its efforts.
In preparing the report on which this testimony is based, GAO reviewed IHiS project expenditures; analyzed key project management documentation; surveyed Coast Guard's Regional Managers and clinical staff; and interviewed key 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.
In the absence of an electronic health record (EHR) system, the Coast Guard currently relies on a predominately paper health record management process to document health care services. Currently, the Coast Guard's clinical staff perform various manual steps to process each paper health record. 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 medications—potentially causing harm to members if they take medications that have dangerous interactions.
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 the 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

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