The Defense Health Agency deployed its new military health system, MHS GENESIS, to 18 military clinics and hospitals in September 2022, bringing the MHS to a total of 97 hospitals and clinics using the new electronic health record (EHR) system, which is interoperable with the Department of Veterans Affairs' own EHR system. Now, from service members' admission into the service through their deployment and beyond, a continuous record exists in the system, allowing for higher-quality care.
But handling the corresponding increase in data volume presents challenges to cybersecurity, interoperability and scalability. MHS GENESIS leaders are now focused on optimizing workflows and data management to avoid cybersecurity pitfalls while maintaining quality of care.
"Rolling out MHS GENESIS is really just the beginning. Even as it's out, we've always struggled with how to optimize their processes when attachments can be added," Ken Johns, CTO for the Program Executive Office, Defense Healthcare Management System (PEO DHMS), said at the annual AFCEA Health IT Summit in Bethesda, MD last week.
The investment in EHR interoperability allows healthcare professionals to easily access patient data to inform decision-making. According to Col. Thomas Cantilina, MHS Chief Health Informatics Officer, there are three big challenges to these consolidations: power, scale, and the speed of light.
"The amount of data we get in with prefetching the HIA … slows down the system that we can't even get it all in time," Cantilina said. "So we have to figure out new technologies to scale that data so that we can get the information."
Speed is also a limiting factor.
"If we look at our overseas deployment, just by definition, electrons around the world take … 120 milliseconds. When you start to hit 200 milliseconds when you take a look at your screen, it's starting to become unusable. That means electrons are just moving around the world without even going through the WALL IE routers," Cantilina said. "So what is going to be in technology, what's going to be a method that can overcome that third barrier."
When managing service members' patient data, Cantilina said it is "the end of the beginning" as they approach the edge of MHS Genesis deployment, where they can start applying predictive analytics and machine learning (ML) to further improve the quality of care.
"A great example of that is we do have that built-in for substance abuse to the point that it gives feedback to the providers, the risk profile of this individual who you just wrote a prescription for Percocet — you might want to reconsider that risk of addiction and substance abuse. The technology grows and grows around that ability to give precision medicine," Cantilina said.
Due to the sheer volume of data available, Cantilina lists monitoring and controlling insider threats as one of the cybersecurity challenges they face in the organization, calling it a "balancing act." Johns emphasized the importance of assessing how resilient the systems truly are.
"The other thing is I like to see the DOD move beyond just the accreditation and look at persistent cyber operations and how resilient is your system really," Johns said. "That has been a good move that I have been supportive of... Given the accreditation standards current to this the speed of hacking is nearly impossible. How the people with the skills and diverse and different teams with the skills go ahead and do what our adversaries are going to do. It really shows real issues and gives you the target to fix. I think our cyber game has improved since I came into the government... But there's always room for improvement, and cyber is always going to be a war of attrition."