In 1979, the Department of Defense started its journey toward electronic health care documentation with computerized physician order entry which allowed physicians to record prescribed medications and view alerts for drug allergies or adverse interactions.

The Composite Health Care System development began in 1988. The Department of Defense's initial health record system made the technological leap from paper to electronic order entry. It also focused on delivering a military treatment facility-centric electronic health record that supported computerized physician order entry and integrated outpatient ancillary services. CHCS worlwide deployment began in 1992.

The Composite Health Care System was deployed worldwide in 1996. CHCS integrated laboratory, radiology and pharmacy; and provided the first hospital-centric clinical support system.

The end of the Gulf War resulted in recognition that an electronic health record was needed. President Bill Clinton directed creation of "a new Force Health Protection program. Every Soldier, Sailor, Airman and Marine will have a comprehensive, life-long medical record..."

The concept of the Composite Health Care System II is born. CHCS II would become the largest system of its kind designed to use structured documentation to collect patient health care information. By 2003, CHCS II deployed to seven facilities for operational testing.

The Composite Health Care System II deployed worldwide in 2004 and was rebranded as the Armed Forces Health Longitudinal Technology Application. Today, AHLTA is still in use in 77 military treatment facilities.

Essentris®, the military’s inpatient electronic health record, was first launched at Landstuhl Regional Medical Center in Germany in 2007 as a counterpart to the Armed Forces Health Longitudinal Technology Application. Essentris provides worldwide documentation of inpatient care for all beneficiaries and a secure, bidirectional data system link for real-time, viewable electronic health information between the Department of Defense and the Department of Veterans Affairs.

Worldwide deployment of the Armed Forces Health Longitudinal Technology Application 3.3 begins. The software was enhanced based on user requests and lessons learned, and improvements focused on upgrading operational availability, speed, provider capabilities and interoperability with the Department of Veterans Affairs.

The services added their own input to Armed Forces Health Longitudinal Technology Application improvements. 

• The Army created the MEDCOM AHLTA Provider Satisfaction program, or MAPS, which made it possible for providers to reduce time required to record notes.
• The Navy piloted voice recognition and spell check software applications.
• The Air Force launched the Clinical Optimization Military Provider AHLTA Satisfaction Strategy, or COMPASS, which focused on streamlining the workflow process. 

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To expedite Department of Defense and Department of Veterans Affairs interoperability efforts, Congress mandated in the FY2008 NDAA that the DoD and VA establish a joint interagency program office to act as a single point of accountability in the development of the electronic health record. As work progressed, it became increasingly clear that the architecture of the Armed Forces Health Longitudinal Technology Application wouldn't provide a suitable platform for a joint EHR. Plans begin for a new EHR. In March 2011, the DoD and VA recommitted to the joint common EHR platform known as the integrated EHR (iEHR).

On Feb. 5, 2013, the Secretary of Defense, Leon Panetta, and Secretary of Veterans Affairs, Eric Shinseki, announced changes in their approach to increasing interoperability between the Departments. Joint actions were identified to accelerate seamless transfer of information across the Departments and replace systems by using a "core" set of applications from existing electronic health record technology. The DoD announces that it is reviewing available commercial and governmental options and the VA decided to use VistA as its core.

The Department of Defense awards Cerner, Leidos, Henry Schein and Accenture the electronic health record contract, and the EHR is branded as MHS GENESIS.

In 2017, the Initial Operating Capability sites go live in the Pacific Northwest with MHS GENESIS. The new, modern electronic health record for patients and health care professionals is designed to transfer a beneficiary's medical information within the Military Health System and with the Department of Veterans Affairs. Lessons learned are recorded from the IOC sites for future deployments.

On Sept. 7, 2019, MHS GENESIS went live at military treatment facilities in California at Travis Air Force Base, Naval Air Station Lemoore, and the Presidio of Monterey, and at Mountain Home Air Force Base in Idaho, as part of Wave Travis, named for the largest wave participant site. Lessons learned from the Initial Operational Capability sites, rigorous testing and improvements to training and change management played a huge role in the successful deployment at those four sites. 

On Sept. 26, 2020, MHS GENESIS went live at military treatment facilities in California at Beale Air Force Base, Edwards Air Force Base, Fort Irwin, Los Angeles Air Force Base, Marine Corps Air Ground Combat Center Twentynine Palms, Marine Corps Mountain Warfare Training Center Bridgeport, Port Hueneme Naval Base, and Vandenberg Air Force Base and in Nevada at Nellis Air Force Base and Naval Air Station Fallon as part of Wave NELLIS, named for the largest wave participant site. The new MHS GENESIS Patient Portal allows TRICARE beneficiaries to exchange secure messages with their care team; schedule medical and (active-duty) dental appointments online; and access notes, labs and medications, and request prescription renewals online.

On Oct. 31, 2020, MHS GENESIS deployed at Wave PENDLETON locations, including military treatment facilities in California at Camp Pendleton and in Alaska at Eielson Air Force Base, Fort Wainwright and Joint Base Elmendorf-Richardson, after months of extensive preparation, undertaken while also navigating through a global pandemic. The transition included intensive training for staff, internal infrastructure changes, communicating to beneficiaries, and equipment upgrades, all completed while continuing to serve those who serve.

On Feb. 26, 2021, MHS GENESIS deployed at Wave SAN DIEGO. This wave consists of Naval Medical Center San Diego (NMCSD) and its ancillary clinics across Southern California; and 1st Dental Battalion. NMCSD is the largest military medical treatment facility (MTF) to deploy the new electronic health record to date. The transition included intensive training for staff, internal infrastructure changes, communicating to beneficiaries, and equipment upgrades, all completed while continuing to serve those who serve.

On April 24, 2021, the Military Health System deployed the MHS GENESIS electronic health record to 25 military hospitals and clinics across 12 states, bringing the MHS GENESIS deployment to nearly 30% complete. MHS GENESIS offers a single system to provide improved access to health care information, and enables a more efficient and timely delivery of care. Wave CARSON+ is the largest deployment to date. This fall, Wave TRIPLER in Hawaii will go live.

On Sept. 25, 2021, MHS GENESIS arrived in paradise with Wave TRIPLER! Military hospitals and clinics in Hawaii now using the Military Health System’s new electronic health record include Tripler Army Medical Center, the 15th Medical Group at Joint Base Pearl Harbor-Hickam, the Desmond Doss Health Clinic at Schofield Barracks, the Naval Medical Clinics-Hawaii and 3rd Dental Company both located at Marine Corps Base Hawaii. MHS GENESIS provides enhanced and secure technology to assist beneficiaries in managing their health information.

On Jan 22, 2022, MHS GENESIS deployed to hospitals and clinics in Waves BAMC and LACKLAND, including the largest military medical center in the Military Health System. The Brooke Army Medical Center, along with hospitals and clinics at Lackland Air Force Base, Randolph AFB, Fort Sam Houston, Dyess AFB, Goodfellow AFB, Laughlin AFB, and Naval Air Station Corpus Christi. In 2022, MHS GENESIS will deploy to an additional 47 military hospital and clinic commands in eight more ‘Waves’.

On March 19, 2022, Waves BRAGG & HOOD consisting of 14 military hospital and clinic commands across five stated deployed MHS GENESIS. Adding in Ft. Bragg, Seymour-Johnson Air Force Base, Marine Corps Base Camp Lejeune, Marine Corps Air Station Cherry Point, 2nd Dental Battalion, Ft. Hood, Ft. Polk, Ft. Sill, Barksdale AFB, Little Rock AFB, Tinker AFB, Altus AFB, Vance AFB and Naval Air Station Belle Chasse increased the total number of military hospital and clinic commands to 68, and also reached the halfway point for total military hospital and clinic commands currently using the new electronic health record system.

In June 2022, the Military Health System increased the number of military hospital and clinic commands using MHS GENESIS to 73 as Waves BEAUMONT and GORDON deployed the new electronic health record. The MHS added Ft. Bliss, Holloman AFB,  Ft. Gordon, Ft. Benning, Ft. Stewart, Naval Submarine Base, Kings Bay and Marine Corps Logistics Base Albany to the list of bases. Eleven “Waves” are currently preparing to deploy the new EHR.

On Sept. 24, 2022, three days before Hurricane Ian made landfall on the west coast of Florida and subsequently impacted South Carolina, Waves EGLIN & JACKSONVILLE deployed MHS GENESIS.

These two large waves added in 23 more MTF Commands at Eglin Air Force Base (2), Naval Air Station Pensacola (2), Patrick Space Force Base, Tyndall AFB, Hurlburt Field, Ft. Rucker, Redstone Arsenal, Keesler AFB, Maxwell AFB, Columbus AFB, Ft. Benning, Ft. Gordon, Jacksonville Naval Complex, Ft. Jackson, Charleston AFB, Naval Weapons Station Charleston, MacDill AFB, Moody AFB, Robins AFB, Shaw AFB and Marine Corps Air Station Beaufort.

The Military Health System has now completed deployment to 92 of 138 MTF Commands.

In January 2023, Waves DRUM & PORTSMOUTH deployed MHS GENESIS to nine military military hospitals and clinics across six states. These two waves included facilities at:

• Ft. Drum and the U.S. Military Academy (West Point) in New York,
• Dover AFB in Delaware,
• Joint Base McGuire-Dix-Lakehurst in New Jersey
• Naval Station Newport, in Rhode Island,
• Hanscom AFB in Massachusetts; and
• Naval Medical Center Portsmouth and Joint Base Langley-Eustis in Virginia.

The Military Health System has now completed deployment to 103 military hospitals and clinics across the United States.