VA Prepares for EHR, AI Priorities in 2024

The Department of Veterans Affairs saw key IT developments this year that included updates around PACT Act implementation, electronic health records modernization and other key concepts such as zero trust.

Now as the agency heads into the new year, it faces continued progress toward these initiatives especially as it relaunches its EHR modernization effort, continues its push for hiring claims processors and other technology talent amid a shifting hybrid workforce, and other administration targets especially around artificial intelligence development.

Hiring, Digital Services Meet Health Care Demands

The VA said it set all-time records in a number of categories when it came to delivering care to veterans in 2023. More than 116 million health care appointments were delivered to veterans, surpassing the previous record by more than 3 million appointments.

A big part of that number were made possible through innovations like telehealth and digital services like the Health and Benefits App, which celebrated its 1 million downloads milestone this year. VA also said in October it will be transitioning the My HealtheVet portal to VA.gov so that users can manage all of VA health care in the same place.

In sum, more than 1.5 million veterans saw more than $163 billion in earned benefits in 2023, including $150 billion in compensation and pension benefits. The VA also processed nearly 2 million veteran and survivor claims, an increase of 15.9% over the previous record. The VA also set new records for engagement, as over 2.4 million veterans applied for earned benefits, a 39% increase from 2022.

Backlog in claims originating from the pandemic spurred more demand for claims processors and automation as well as address the influx of hundreds of thousands of PACT Act-related claims. Since the PACT Act’s passage, 76.7% of the 710,000+ PACT Act-related claims have been approved.

All of this was done by a workforce that expanded to more than 400,000 employees at the Veterans Health Administration and more than 32,000 employees at the Veterans Benefits Administration. VA across the board plans to hire nearly 52,000 employees per year over the next four years.

EHR Program Reshuffles

The VA froze its electronic health record modernization program in April 2023 and paused future rollouts as leadership conducted an assessment and realignment of the program.

The freeze followed an “assess and address” period, during which the agency drafted a report about needed changes to mitigate existing issues with accuracy, enterprise standardization and reliability of data in the new EHR.

“We’ve heard from veterans and VA clinicians that the new electronic health record is not meeting expectations — and we’re holding Oracle Cerner and ourselves accountable to get this right,” VA Secretary Denis McDonough said in a press release at the time of the freeze. “This reset period will allow us to focus on fixing what’s wrong, listening to those we serve, and laying the foundation for a modern electronic health record that delivers for veterans and clinicians.”

The Oracle-Cerner EHR program is likely to pick back up in the new year. In September, Tanya Bradsher was confirmed as the agency’s deputy secretary — whose role is to oversee the program. Bradsher embarked on a listening tour of the five sites using the new record as she builds a robust plan for it in 2024.

“Right now, with the reset, we are taking a hard look. We’re working with our clinicians and making sure that we are up and running,” Bradsher said of her listening tour. “This is a wonderful opportunity for me to learn from our clinicians and to bring back not just what I’m being told sitting in meetings and on Teams, but to actually see it on the ground, see how it’s working, see if it’s up.”

The next rollout is scheduled concurrently with the Defense Department’s rollout of MHS Genesis at the Lovell Federal Health Care Center in North Chicago.

Sites that have not taken on Oracle-Cerner have continued to use the VA’s legacy system Veterans Health Information Systems and Technology Architecture (VistA) Computerized Patient Record System (CPRS) to deliver health care.

VLM Doubles in Size

The digital Veteran’s Legacy Memorial saw its largest expansion this year since its creation in 2019. The platform grew from 4.8 million records in May to 9.8 million by Veterans Day.

The nearly 10 million records were pulled from databases from VA cemeteries, DOD-managed cemeteries including Arlington Cemetery, 13 of the 14 National Park Service cemeteries and from the more than 4,000 veterans laid to rest in 87 countries.

“This particular effort of adding nearly 5 million additional pages was fairly complicated. We were tapping into a database that was new for us,” James LaPaglia, digital services officer at the National Cemetery Administration, told GovCIO Media & Research. “Within that database, there were all kinds of variations of locations and addresses and cemetery names.”

Approximately 80,000 new records came from state, tribal and territory cemeteries and new gravesites like Gettysburg and New York’s Green-Wood Cemetery, were added to the database. All in all, over 73,000 tributes have been inputted into the database.

Modernization in 2024

Looking forward into 2024, some of the agency’s largest priorities will center around building frameworks for AI and EHR modernization.

VHA’s National Artificial Intelligence Institute was one of the major players behind the White House’s Blueprint for an AI Bill of Rights, which outlined the need for agencies to develop AI that is fair and trustworthy. That was followed this year by Biden’s executive order directing agencies on how to do so, as national interests in harnessing the technology for national security and maintaining a competitive edge globally grows.

The institute kickstarted an AI Tech Sprint to spur creation of AI-enabled tools to help reduce employee burnout.

According to the VA, these tools have helped decrease employee burnout 20% between 2022 and 2023.

“AI solutions can help us reduce the time that clinicians spend on non-clinical work, which will get our teams doing more of what they love most: caring for Veterans,” Under Secretary for Health Shereef Elnahal said in a VA statement. “This effort will reduce burnout among our clinicians and improve Veteran health care at the same time.”

The VA will also hold a competition to reward a $1 million prize to winning teams that create solutions in two key areas:

• Speech-to-text solutions to be used for notetaking during medical appointments.

• Document processing for faster integration of non-VA medical records into a patient’s VA record.