The Defense Health Agency’s Pay-It-Forward program was designed to leverage the experience of those who had gone through the Department of Defense transition to new modern electronic health record, MHS GENESIS, to help new users.

And, according to Navy Cmdr. Victor Lin, Navy Medical Forces Pacific chief medical informatics officer, it's working.

"These SMEs (subject matter experts) impart invaluable knowledge to new users, enabling a successful go-live evolution," he said.

The program started during the go-live for MHS GENESIS at Nellis Air Force Base in Nevada in September 2020, according to Air Force Col. (Dr.) Thomas Cantilina, MHS chief health informatics officer and the deputy EHR Functional Champion.

"Similar rollouts occurred at (Marine Corps Base) Camp Pendleton and (Naval Medical Center) San Diego and we have just completed additional rollouts at 25 other MTF (military medical treatment facility) commands within Wave CARSON plus. Our goal has been to ensure safe healthcare delivery during this transition," Cantilina said.

Once fully deployed across the enterprise, MHS GENESIS will provide a consolidated electronic health record for service members, retirees, and their families that will integrate inpatient, outpatient, medical and dental information from point of injury to definitive care.

New methods of training are evolving as the rollout continues. Initiatives like Pay-it-Forward demonstrate success through deployment of individuals who have completed the training and the go-live event, assisting new users and sharing their real "on the job" experience at future sites.

The initial operating sites were in the Pacific Northwest, which started to go live in February 2017.

"It was hard," said Christopher Gruber, MHS GENESIS project officer on DHA's Health Informatics team. "We had a real hard time adopting."

Gruber said that a year later, when the next waves were starting, the commanders at Madigan Army Medical Center at Joint Base Lewis-McChord and Naval Hospital Bremerton, both in Washington state, realized, "we've got people who have been using the system – we'll send people down to help."

"The services, of their own accord, sent their smart folks, their subject matter experts in different clinical areas," Gruber said.

It takes about 12 to 15 months to train people on MHS GENESIS, he noted.

"The Leidos Partnership for Defense Health (LPDH) sends coaches in, and architects, to help you with that transition process," Gruber said. "Well, what we discovered when LPDH built the system, they know how it was intended to be used, but they (didn't) have any experience in actually using it."

Michele McCormick, Chief of End User Engagement for DHA Health Informatics, noted that there is a big cost to send people on temporary duty, pulling them away from their position at their current facility, and from home.

"But the dividends, the payoffs, are huge," she said. "We are already getting feedback from our end users at sites where we haven't even gone live yet. When your customers start, word-of-mouth, saying, "Hey, we had people come here and help us learn the system," that is huge.

"We don't have to actually advertise this. Folks are hearing about it and asking, "When am I going to get my Pay-It-Forward people?" It's probably one of the best programs we've put in place in terms of supporting our end-users. We have seen a significant change in behavior in adapting to the system."

Said Cantilina: "So far, we've seen good results with our volunteers staying for one week. But we're open to exploring other durations of time as needed."

McCormick said the Pay-It-Forward program is about peer-to-peer.

This is 'I'm a provider in behavioral health medicine, and I need to talk to another provider in behavioral health medicine about how my flow is going to change, and how I'm going to be able to use the system and adapt to it quickly,'" she said. "That is the essence of it. That your peers are helping you adapt. You've got somebody sitting there at your elbow who is just like you and performs the same work you do, every day.

That's really the connection of the Pay-It-Forward program. Every three to six months another five to 20 hospitals go live, then we keep moving," concluded McCormick.