VA Focuses on Continuous Improvement for 2025 EHR Rollout

The Department of Veterans Affairs will focus on “what it means to do continuous improvement of health IT systems to support the needs of [its] end users” once the agency resume rollout of its electronic health record (EHR) in fiscal year 2025, Neil Evans, acting program executive director at the Electronic Health Record Modernization Integration Office, said at the VA Digital Healthcare Summit at the National Press Club this week.

“One of the things we as an organization have spent time learning is the muscle memory of what it means to do continuous improvement of health IT systems to support the needs of our end users,” Evans said. “In this particular case … continuous improvement never stops. The work we’ve been doing during reset isn’t going to stop when we get restarted.”

Laura Prietula, deputy chief information officer at the Electronic Health Record Modernization Integration Office, said the agency wants to ensure acquisition specifications enable the use of innovative technology, especially as tools like AI become more prominent in daily operations. As the agency continues to build out a modern EHR, it’s important to ensure the integrated tech isn’t outdated by the time it goes live.

“We have these technical specifications that we started with in 2018. We’re bringing them to speed up requirements that we have today. But you need to help us think about what should that other, next technical spec be. We don’t want to be purchasing things right now for all the other facilities [if] it’s going to age very, very quickly,” Prietula said.

The rollout has been in a reset phase since April 2023 following reports that the system struggled with accuracy, enterprise standardization and reliability of data. Currently, the modern EHR is only in place at six sites throughout the VA, with the most recent deployment occuring in March 2024 at the Lovell FHCC in North Chicago.

VA Secretary Denis McDonough said at a press conference this month that his team has not yet met with president-elect Trump’s transition team, but plans to update them on the progress of the EHR rollout.

McDonough mentioned that since the EHR went live, the six active sites have seen decreased wait times, less interruptions in patient care for clinicians and increases in clinician and staff satisfaction. However, he also noted that there remained dramatic room for improvement.

“We’ll be sharing all of those findings with the transition team, but remember that there is a relatively small number of political appointees here at VA. The overwhelming majority of VA professionals who work on EHR will be working on EHR on January 21, just as they were on January 19,” McDonough told GovCIO Media & Research.

Gilly Cantor, director of evaluation and capacity building at Syracuse University’s D’Aniello Institute for Veterans & Military Families, told GovCIO Media & Research that the main concern for veteran-focused organizations is that the new system does not further increase burdens on veterans.

“The thing we’re most looking for is making sure that the veteran, in this case, as the patient and/or their family member, is at the center of those decisions, and that they are not put in a worse spot navigating through an already complex health care system,” Cantor said.

Evans said the main challenge of implementing the federal EHR is operating at scale while balancing the demands and feedback of veterans on a personal level, who will ultimately be the ones affected by the changeover.

“The way we do cool stuff at scale is we stay focused on outcomes, what the user experience is, what the individual user is feeling, but also, how we do things at scale. And in there always exists some level of tension,” Evans said.