Thursday, February 01, 2018

Disastrously conceived, managed, and implemented U.S. Coast Guard EHR leaves our Coast Guard heroes safer ... after reversion to paper records

Sometimes, the typical EHR mismanagement debacles that I have been writing about since at least 1999 leave patients safer.  This is one such example.

I note that the contents of this blog, as well as my still-extant Drexel website "Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties" ( and many other resources about healthcare IT mismanagement and failure, are available free of cost.  They could have saved the Coast Guard many millions of dollars if their contents had been reviewed and taken seriously.

(I take no pleasure in making these observations.)

As a consequence of just the latest example of gross health IT mismanagement, a forced reversion back to paper will be far safer than this catastrophically bad health IT would have been, had it been turned on:

After failure of EHR program, Coast Guard needs to find new solution ASAP, watchdog says
Zaid Shorbajee
Fedscoop News
January 31, 2018
The U.S. Coast Guard must urgently find and implement a new electronic health records system, the Government Accountability Office says in a report, after a past project that took half a decade failed and left the organization using a paper process.

The Coast Guard began working with Wisconsin-based Epic Systems in 2010 to implement a new EHR system, dubbed Integrated Health Information System (IHiS). Over the following five years, the project faced multiple setbacks and delays, according to the GAO. IHiS was ultimately scrapped in 2015, with nearly $60 million spent as of August 2017 and some payments still to be made.

The Coast Guard came away with no software or equipment from the project to be used for the future. To make matters worse, in the two years since IHiS’s cancellation, the Coast Guard had to also decommission its two legacy EHR systems because they did not comply with international standards.

Put more simply, $60 million and counting went down like the Titanic in a five-year project.  Why?

The GAO report says the project failed because of “financial, technical, schedule, and personnel risks.” At a House Transportation and Infrastructure Committee hearing on Tuesday, Coast Guard representatives admitted fault.
“What began as a project to develop a simple electronic health record increased in scope and expanded into a much larger concept which added work life and safety services,” said Rear Adm. Erica Schwartz, the Coast Guard’s director of health, safety and work-life. “This project lacked appropriate oversight and governance and resulted in a project that had significant mission creep, untimely delays and increased cost.”

First, I am impressed that Coast Guard representatives took some responsibility. 

However, health IT projects with deficient oversight, governance, financial, technical and other defects have been the constant topic of my writings, and that of some others in Medical Informatics, dating back two decades.  It seems the lessons learned from past failures such as at and at this blog via query link may be beyond the comprehension of what can be called "the usual IT suspects."

With no system to fall back on, the Coast Guard has been working with a mostly paper-based process to manage health records for about 50,000 service members.

I find that, in fact, comforting.  The Coast Guard service members are safer compared to what would have transpired if this Frankenstein system (as with the fictional Golem by that name) had actually become "live."

The report doesn’t identify the names of any of the vendors. Epic Systems did not respond to request for comment, but the company’s website says it fulfilled the terms of the agreement and that its software was ready to live when IHiS was cancelled.

The Coast Guard did not respond to request for comment on whether the software was indeed ready.

I believe the vendors to be the usual Beltway Bandit suspects, and I am not sanguine about EPIC's reports.  That's just my personal opinion, of course.  However, just prior to embarking on this post I have begun to review an EPIC chart of a deceased patient, and find a pile of legible gibberish that, had I documented that way as a medical student, would have earned me the "Professor Kingsfield" treatment regarding a U.S. ten-cent piece and a phone call to my mother (

Testifying at the same hearing, David Powner, who directs IT management issues at the GAO, listed several indicators of IHiS’s poor management. Among the things that slowed it down were questions about whether the Coast Guard was using appropriate funding sources, limited security features in the system, failure of the Coast Guard to properly follow its own acquisition process, and the non-involvement of executives who should have been involved.

The GAO report notes while the Coast Guard created several governance boards to oversee the planning of IHiS, the Chief Information Officer was not included on any of them.

That omission is, in a word, an extreme example of IT mismanagement.

“You could have the best project management on these technology projects, but if you don’t have executives that are accountable and breathing down the neck of project managers – that’s what makes this stuff work,” Powner said at the hearing.

He also expressed concern about the paper process currently in place, calling it “inefficient and dangerous.”

It is a shame that the IT world seems to lack altruism, teamwork, cooperation, etc. and instead needs to be brow-beaten into producing reasonable products.   (In what field is altruism, cooperation, shared responsibility and teamwork relatively common?  Answer - medicine.)

As far as paper being "inefficient and dangerous", I ask: compared to what?  Bad health IT?  See my Jan. 31, 2018 essay "The inevitable downgrading of burdensome, destructive EHRs back to paper & document imaging" at for more on that issue.

In fact, I hope the Coast Guard is using a efficient document imaging management system at present with their paper.  If not, that is yet another blunder.

The GAO report says that the Coast Guard did not formally identify any lessons learned from the failed IHiS project.

Perhaps because bureaucracies and their IT personnel are unteachable?  That is perhaps not an entirely unreasonable conclusion after all the writing I've done or read since my entry into Medical Informatics at Yale School of Medicine in 1992.

Finally, if the Coast Guard needs a new leader for this initiative, I offer my services. 

I would demand, however, unfettered hire/fire authority, as well as a Sherman tank as my office, such as my father (lower right) used to transport around Europe in WW2.

My father, lower right, somewhere in Europe ca. 1944-5.

-- SS


Live IT or live with IT said...

Any system will be outmoded within a five year plan. That's part of the whole problem here.

InformaticsMD said...

Live IT or live with IT said...

Any system will be outmoded within a five year plan. That's part of the whole problem here.

Health IT costs, even without the massive industry profit generation they are characterized by, will never be recaptured by "efficiency." The $$$$$$ spent on IT could also pay for a great amount of care for minorities and the disadvantaged, instead of being diverted to the IT industry.

-- SS