MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- Madigan Army Medical Center is moving into the role of center of excellence for the Department of Defense's new electronic health record MHS GENESIS.

Since Madigan transitioned to the system in October 2017, subject matter experts from across the medical center have hosted a wide range of those seeking insight and a firsthand view of the EHR.

From optimizing a commercial system for military use to helping smooth the way for Wave 1/Travis sites that switched on the system on Sept. 7, Madigan's role has been significant in the adoption of the EHR.

"Overall, given where we were three years ago with MHS GENESIS -- the evolution of the product -- it's incredibly better than it was, and a vast improvement over our old system," said Dan Gardner, the chief of Outpatient Pharmacy.

Gardner was involved in a recent tour of a number of Madigan departments that have overcome challenges in implementing MHS GENESIS for Dr. David (Phil) Roe, representative for Tennessee's 1st Congressional District and ranking member of the House Committee on Veterans' Affairs. Roe was accompanied by Maj. Gen. Lee Payne, the assistant director for combat support for the DHA and MHS GENESIS functional champion, on the Sept. 30 visit.

Madigan has been instrumental in aiding the Defense Health Agency in its understanding of how the system impacts the end user. But, Madigan's reach in impacting the widespread of the EHR has also touched the U.S. Department of Veterans Affairs.

As the VA moves forward in its own acquisition and planned implementation of MHS GENESIS, Madigan is introducing VA leaders as well as representatives from Congress to it. From DHA to the VA, MHS GENESIS has been on people's lips; and admittedly not always for the best of reasons.

Lt. Col. Jaleh Ghalandarysafavi, the deputy chief of the Outpatient Pharmacy, did not refrain from mentioning some of the challenges the system has presented.

"Everything being said, all the challenges, the system has a lot of good features that we did not have in the legacy system. The only thing is that we have to learn it," she said.

Following an introductory brief on MHS GENESIS, Roe was led on a tour of the Department of Emergency Medicine, the Post Anesthesia Care Unit, the Intensive Care Unit, the Core Lab and the Outpatient Pharmacy, with each stop involving a view and discussion of the use and impacts of the EHR in that area.

Roe's engagement with Gardner in the Outpatient Pharmacy was indicative of the aid that Madigan is giving its cohorts in the transition to MHS GENESIS.

He asked about the equipment needed, the process involved in ordering a prescription and the time that elapses between the doctor ordering and the patient picking up the medication in the pharmacy.

Roe's deep understanding of these issues stems from his background in medicine.

After graduating with his medical degree from the University of Tennessee in 1970, Roe did a two-year stint in the Army Medical Corps, followed by over 30 years in private practice.

An example of the changes made to improve the efficacy of MHS GENESIS was the review and streamlining of coding for medications. As Ghalandarysafavi explained, the dispensing systems had multiple identification numbers for the same medication.

"That's an example of unwanted variation in our system, of what standardization is bringing to us," said Payne.

Identifying and addressing these systemic challenges perfects the EHR's ability to function as a fully integrated system both between facilities within the military and with the VA, once they go online with their own version of the system.

As Roe pointed out, "80 percent of veterans have other health insurance other than the VA. So, that's why an integrated system is so important."

Madigan is at the forefront of this integration and has a leading role in demonstrating and optimizing the EHR to those who will adopt it in the future.

"We're already working with both the VA and TRICARE and Pharmacy Benefit Management. We're already looking at dual eligibles," said Payne.

Madigan will continue to share its knowledge of MHS GENESIS with a wide variety of stakeholders in the future.

Just as the trek for implementation of MHS GENESIS started in the Pacific Northwest in 2017, the VA will have its initial operating capability sites with VA facilities in the area in spring 2020. DoD IOC sites, including Madigan, will continue to provide support, expertise and insight.