VA Eyes Next Steps Since Joint EHR Rollout

It’s been five months since the Department of Veterans Affairs launched its electronic health record jointly with the Defense Department at their North Chicago facility, and program officials said they are keying in on continuous user experience improvements.

“In the past year, more than 1,500 system configuration changes have been implemented, and more than 1,000 incident tickets have been resolved,” Dr. Neil Evans, acting program executive director of VA’s Electronic Health Record Modernization Integration Office, told GovCIO Media & Research. “As a result of these efforts, we have seen the core federal EHR increasingly stabilize, resulting in significant improvements to the user experience.”

According to Evans, Lovell is making EHR improvements from the “mindset of a learning organization,” based on user feedback and prior experience with the EHR. Currently, the team is working to improve “big rock” projects, which require “more than a simple fix.”

“Some examples of these ‘big rocks’ include revisiting the approach to referral management, further improving training for new users, standardizing and consolidating user roles in the system, [and] delivering a key pharmacy capability referred to as ‘Pharmacy 3b/3c’ to improve coordination between ordering clinicians and pharmacy professionals,” said Evans.

Evans also said VA had received positive feedback on some of its new training methods that launched with the new system at Lovell, and VA plans to change its process for managing system configuration changes.

Change Management for EHRs in Focus

Lovell Director Dr. Robert Buckley noted the challenge with launching an integrated EHR across such large networks as VA and DOD.

“There’s certainly been challenges along the way and opportunities to learn from, but I can tell you this: our staff understands the value this brings all of those entrusted to our care, our veterans and those that will someday be veterans,” he said during a House Committee on Veterans Affairs Subcommittee on Technology Modernization Oversight hearing. “Adoption of a new health record and a change at this magnitude is, no kidding, hard. It really is hard.”

The Military Health System’s biggest challenge with its EHR, MHS Genesis, has been change management and ensuring the adoption of the new standards.

“That was the hardest thing of this whole deployment — and it still is today,” said Chief Health Informatics Officer Col. Thomas Cantilina in August. “How do we help the end user understand how to change their behavior? Or as I like to say, get them out of ‘legacy think’ as they move forward?”

Cantilina, who is set to retire from duty in October, said the new system has enabled the ability to make changes more quickly and that DOD should look to make improvements gradually rather than look for the perfect solution.

“It’s easy to say, ‘If only the system did this,’ and get caught up in trying to achieve the ideal. It’s better to think, ‘How can we make what we have work a little better?” Cantilina said. “You run into trouble when you search only for the perfect solution rather than work to improve upon what you have. Perfection is the enemy of getting better.”

According to Evans, VA will continue to “listen to and engage with clinicians and staff about their experience with the federal EHR” as improvements are implemented.

“Outside of improving the federal EHR product itself, VA is providing increased support to staff by adding change management and training opportunities and implementing a more responsive and transparent ticket management system,” he said. “We are also improving on-site support during and after go-live, providing learning opportunities for peers to share tips and tricks, and enhancing communication with end users.”