EHR Leaders Offer Update on Agency Deployments

Electronic health record modernization is one of the government’s largest undertakings. It is eliminating siloes in the Defense Department, Coast Guard and Veterans Affairs to better serve clinicians and patients alike in their health care.

Federal leaders at the GovCIO Media & Research Health IT Summit spoke last week about the progress the EHR deployment has made, the challenges along the way and how their agencies will continue their deployments.

Clifford Wilborn, Joint Sharing Sites—Federal Health Care Center director at the Federal Electronic Health Records Modernization (FEHRM), praised the development of the EHR and how its capabilities have united disparate health records between the DOD and VA together “seamlessly.”

“We are able to now seamlessly work between the departments in one platform that will definitely pay long term benefits in terms of efficiency, cost reductions, improved care and delivery of care to our benefit, to our patients,” Willborn said. “We’ve got that platform in place, and I think the long term is it really paved the road for how we can all work together in a joint space collectively and put aside our differences and policy differences in the way we do business and just get the job done.”

Terry Luedtke, chief architect and product engineering director, EHRM-IO at the VA, said that the VA’s current pause on EHR deployments is comparable to DOD’s own deployment pause, and designed to understand what works and what doesn’t before moving on to deployment at a much larger scale.

“DOD delivered a few sites and then took a pause to really go back and look at how they optimize what they’ve learned before going forward, and we’re doing the same thing. It’s really very common in a large healthcare system to pause on a rollout, to go back and look [and say]: ‘Here’s all our assumptions, which ones really fit?’ That’s the stage we’re in right now, looking at that and seeing what should be changing, what does or doesn’t work in our space,” Luedkte said.

Luedtke emphasized the need for structure, governance and process when it comes to EHR deployment and pointed out the creation of the FEHRM’s role in ensuring those standards now exist.

Listen to the user

Despite the VA’s broader subset of healthcare coverage, it has managed to take some of the lessons learned from the DOD and utilize them in the VA’s own deployment, Luedtke said.

“Certainly, we learned a lot from DOD, especially the early deployments, as we were just trying to configure and get together on our new journey,” Luedtke said. “The VA is very different in its mission than DOD. We certainly have a broader scope of healthcare, more complex conditions that we’re caring for, so we had a broader subset of the EHR to configure.”

He mentioned that there is value in listening to the user and gaining firsthand experience with the system as much as possible. Luedtke spoke about a tech clinic team comprised of clinicians, Office of Information Technology experts and experts with Oracle Health that are tasked with physically going to sites to examine their challenges and then finding solutions collaboratively to deal with them.

“It doesn’t matter how much training you get or how much the vendor tells you about their system until you actually get it in your environment live and you’re working with it,” Luedtke said. “That’s when you really learn how things work, what your assumptions were, even if you didn’t know they were assumptions.”

Interoperability at the core

Monica Rosser, executive managing director of Federal Health at Maximus, said that lessons learned over the past decade of EHR modernization has built up a well of knowledge on how best to make health systems interoperable from the start.

“We’ve now done enough deployments together over the course of a decade long enterprise that we know what works. We know what doesn’t work. So bringing in those clinical champions early, really focusing in on the total user experience,” Rosser said. “It’s that whole pattern and interoperability of trust between agencies that I think are really going to drive us forward in the interoperability space.”

Luedtke said that while the data side of interoperability is solved by the creation of the EHR, the main challenge that remains is one of “process interoperability” as disparate agencies and departments learn to work together to make the EHR work as intended.

“It opens up a whole area of more process interoperability, where we have more opportunity to share, as well as to streamline existing sharing agreements, because there’s a lot of cases where VA or DOD will share their capabilities,” Luedtke said.

Willborn referenced the DOD’s “Pay It Forward” program as a major success in EHR implementation. The program was designed to take employees who already understood the EHR system to go and work side by side with those still learning the ropes, increasing familiarity with the system across the enterprise.

“Now that we’re now on the same platform as both departments and we get to the pre transition and for the joint sharing sites, from the interim to the end state, we’ll be in a very good position,” Willborn said.