Solving EHR Maintenance and Innovation Challenges with CAPT Chris Tatro

The Defense Health Agency’s CAPT Chris Tatro, MD, talks with Harry Greenspun, MD, about his award-winning enterprise issue resolution process to resolve complex EHR updates quickly and sustainably across sites.

One of the most important lessons in medical school is also helpful in everyday interactions: understanding the reason why someone is asking a question—as opposed to focusing on the question itself—provides more valuable insights into their needs and concerns. This applies in doctor-patient and personal relationships, and in work-related situations. Good doctors practice this “why” behind the “what” approach to benefit their patients, colleagues, and themselves.

One such doctor is CAPT Chris Tatro. After serving as an OB/GYN physician in the U.S. Navy, he completed a fellowship in clinical informatics and joined the Defense Health Agency (DHA) as its Division Chief of Health Informatics. CAPT Tatro leads 15 cross-functional solution teams in the transition to optimize and standardize the Department of Defense’s (DoD’s) enterprisewide electronic health record (EHR), Military Health System (MHS) GENESIS. He was recognized for this work’s “Issue Resolution Process” by FedHealthIT in 2022.

During the process of standardizing the DHA’s EHR across hundreds of clinics and scores of hospitals and medical centers, CAPT Tatro identified the need to innovate to solve the array of problems that inevitably arise in a project of this magnitude. His team faced a barrage of questions and requests to address from multiple departments and facilities. With limited resources, it became increasingly difficult to identify, analyze, and adjudicate inquiries.

I recently spoke with CAPT Tatro, and he underscored that ultimately it is people who determine the success of this project. And central to that success is trust.

Why People Determine the Success or Failure of EHR Standardization

As requests flowed in, if employees didn’t feel understood or trust a response, major problems arose. Seeing this, CAPT Tatro led the development of a functionally driven enterprise issue resolution process to resolve complex EHR content and configuration changes quickly and sustainably across sites.

 

Because enterprise systems need to be scalable and sustainable, they cannot solely reflect the preferences of one group, nor can users expect that whatever they ask for will be done. However, some of the issues surfaced are critical, so leadership needs a seamless way to learn about and address them. To do so, CAPT Tatro assigned project managers to various sites, in person, to gain a greater understanding of end-user experiences across departments, as well as to build more trusting relationships.

What Sustainable and Scalable EHR Issue Resolution Needs

In gathering information, CAPT Tatro’s team worked with Guidehouse to develop a process to clearly outline how local sites, DHA, and DoD project managers submit and manage issues to resolution. For example, when users submit change requests, the issues are routed to appropriate solution teams for review in collaboration with DHA clinical communities to ensure DoD can continue to provide quality care with MHS GENESIS. CAPT Tatro also led the team’s transition to the MHS service help desk, enabling all participants to better track resolution of their requests. Together, these innovations, among others, have led to an agile, iterative, end-user-focused system that promotes seamless learning, collaboration, and optimization.

The resulting enterprise issue resolution process is now embedded in every go-live project, with more than 50 military treatment facilities having deployed MHS GENESIS by 2022 and additional sites going live throughout 2023. It has helped the DoD reimagine what is possible and continuously improve the EHR integration process. It even led to a joint DoD/Department of Veterans Affairs governance partnership that enables a consistent EHR experience for U.S. service members and Veterans.

While the focus has been on the DHA, the challenges of standardizing an EHR across a large healthcare enterprise are common throughout the industry. By learning the daily experiences of the people who interact with EHRs, leaders can better understand the “why” behind the “what” to successfully optimize and standardize their systems.

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