Two years after the Coast Guard announced it was cancelling its electronic health record (EHR) project, the service continues to rely on a paper management system. That poses serious risks for personnel, a new Government Accountability Office report argues.

According to the report, Coast Guard regional managers and clinic and sick bay administrators warned the GAO they are “unable to adequately track vital information such as medications,” which puts personnel at risk of medical complications.

The Coast Guard’s failed EHR modernization effort — known as the Integrated Health and Information System, or IHiS — was terminated yet still cost $59.9 million between 2010 to 2017 (with no equipment or software reusable for future efforts).

The report further outlines that IHiS did not undergo an independent security assessment and interface testing, potentially compromising the sensitive health information of the service’s 56,000 members.

Without an electronic system, clinical staff must handwrite clinical notes into the paper record, handwrite prescriptions and schedule appointments with Microsoft Outlook and print off paper forms for patients when they arrive at the clinic (rather than online before their visit).

The top four problems reported by clinic and sick bay managers are: incomplete medical records, penmanship, tracking changes in health records and medications, as well as the amount of time it takes to manage health records manually.

To remedy these issues, the GAO recommends the Coast Guard “expeditiously and judiciously pursue the acquisition of a new EHR system,” while documenting lessons learned from IHiS to ensure key processes and proper governance mechanisms are implemented.

On Jan. 30, Rear Admiral Erica Schwartz, director of Health, Safety and Work-Life, testified before the House Transportation Coast Guard and Maritime Transportation Subcommittee on the service’s dire need for a permanent EHR solution.

“The Coast Guard cannot continue without an EHR long-term ... we must have an EHR system that is interoperable with the [Department of Defense] and one that allows our members to efficiently transition to the [Veterans Affairs],” said Schwartz.

David Powner, the director of information technology management issues for GAO, also testified that “the Coast Guard needs to strongly consider the EHR solution that DoD and VA are pursuing.

Although the Coast Guard sent out a request for information regarding a new electronic solution in April 2017, a decision has yet to be made regarding any long-term EHR solution.

When asked by Chairman Duncan Hunter why the Coast Guard would not just use the system that DoD has right now, Rear Admiral Michael Haycock, assistant commandant for acquisition and chief acquisition officer for the Coast Guard, responded, “We’ve done an analysis of alternatives which is looking at what exists out there for us as potential solutions. One of those solutions is using a federal service provider. That is the solution we would like to go for.”