FEHRM CTO Targets Two-Year Cloud Migration for Federal EHR

The Federal Electronic Health Record Modernization Office is targeting new tech advancements for the federal EHR, including moving to the cloud, boosting interoperability through new information exchange programs and integrating AI, the office’s  CTO Lance Scott explained earlier this month during the 2025 ACT-IAC Health Innovation Conference in Reston, Virginia.

Moving the Federal EHR to the Cloud

Federal EHR agencies will transition the EHR to the cloud in tranches, according to Scott, and the deployment could take nearly two years to complete as agencies develop “flexible scalability.”

“We want to take advantage of the inherent native cloud services that we’ve got. It’s no small feat. It’s going to take better part of 18 months to two years to do,” Scott said.

Scott said that his team is working to ensure that the transition is as seamless for the user as possible as the EHR continues to be developed and moved to the cloud. Ideally, the user would not recognize a significant change as the system switches over.

“We’re trying to keep as much functionality turmoil out of the mix as possible to make sure that we don’t impact the users too much now. However, what we’re doing is we’re setting the stage,” Scott said during the conference.

Despite the potential promise of the EHR, Scott said he still has lingering concerns about cost increases of the modernization effort as it moves to the cloud, specifically hidden costs that have yet to materialize.

“I think the biggest thing that I’m worried about is functionality that’s going to be enabled by us going to the cloud that we haven’t looked at yet, that will cost extra money,” Scott said. “As far as the general move to the cloud, I don’t think I’ve seen any use case that says that it makes more sense to stay on prem.”

Expanding the Seamless Exchange Program

Scott said the Department of Veterans Affairs’ Seamless Exchange program is “finally reaching fruition.” VA first piloted the program in last year in Walla Walla, Washington. The pilot was successful enough that VA plans to launch the program on a wider scale in November of this year. The program offers new opportunities for interoperability between the Defense Department and VA, and DOD intends to roll out its own Seamless Exchange capability following the success of the VA program.

“The reason why it’s so exciting is years ago, my focus was to get more data, get more partners, do as much as we can to bring in data. Now we’ve got 96% of the U.S. market that we exchange data with. Now we’ve got another problem. The problem is information overflow,” Scott said.

The seamless data exchange is built upon three foundational pillars: data de-duplication, which Scott said has a huge impact on performance and cost; data provenance, as data shared over and over between partners loses its origin; and auto-ingestion, which brings in data from hundreds or even thousands of partners and needs to be analyzed by clinicians to drive best outcomes.

According to Scott, lessons learned from these pilots will directly affect the deployment of the EHR and lead to better outcomes overall. The VA is currently on track to deploy the EHR at 13 new sites in fiscal year 2026 following a nearly three-year deployment pause.

AI’s Role in the Future Federal EHR

Within the DOD, Scott pointed to U.S. Military Entrance Processing Command, which uses data gathered by the EHR to filter candidates looking to join the military. The influx of data has allowed employees to sift through candidates at a much more efficient pace and approve or decline candidates based on a number of factors, such as medical history or drug use.

In the future, Scott says the next generation of the EHR will be AI-enabled, with new technologies augmenting the ability of clinicians to provide quality care.

“They’re going to have digital assistants. They’re going to have ambient listening. There’s going to be agents listening into what the doctor and patient talk back and forth about,” Scott said. “They actually will draft up diagnoses and notes for the clinician to look at and finalize and sign.”