VA’s Electronic Health Record Modernization: Innovating and strengthening with each new deployment

By Terry Adirim, M.D., M.P.H., M.B.A.

The Department of Veterans Affairs is undertaking a historic enterprisewide effort to modernize its electronic health record system, but we shouldn’t let the enormity and complexity of the task stand in the way of this important innovation.

Despite a rocky start, the program is on the right path. We’ve experienced two successful deployments and continue to learn from these and others, making improvements and measurably strengthening at each upcoming site.

The new electronic health record system, and its standardized approach to clinical and business operations, represents an important and fundamental shift in the way care is delivered to veterans and their families. Our veterans deserve world-class care, and our health care personnel will now have the modern tools they need to support continued delivery of that care.

The VA’s nearly 40-year-old electronic health record system was long overdue for an overhaul when the VA’s modernization process began in 2017. And the new EHR does what the legacy system does not: provide a seamless health care experience for both clinicians and patients, capturing health records and care information for every veteran, from the time of military enlistment, through active service, and across the transition to the VA.

We acknowledge the deployment of the electronic health record system at the VA’s first site at Mann-Grandstaff VA Medical Center in Spokane experienced difficulties. The VA conducted a comprehensive 12-week strategic review to identify problem areas, mitigate those problems, and make the needed adjustments. This included improvements to the patient experience, training for frontline personnel, and ensuring greater engagement among leadership and staff.

We continue to address and correct these problems, as ensuring an effective and safe electronic health record system at Mann-Grandstaff remains a key priority. Moreover, we are providing dedicated and ongoing support to the workforce at Mann-Grandstaff, as well as other sites that have also moved to the new system.

Transitioning to a new, modernized electronic health record is difficult, especially doing so within the largest integrated health care system in the country. Any rollout of this scale and complexity understandably comes with challenges. They were expected.

As a practicing physician for almost 30 years, I’ve experienced electronic health record system replacements and implementations before. Our commercial-sector peers struggle with similar issues every day. Learning new processes takes time and can be hard. There will always be challenges regardless of the industry or organization leading the change.

For the VA, we’ve learned from our experiences and have made numerous improvements to the system itself as well as to our processes, training, and support of personnel for upcoming implementation sites. The VA, as a high reliability organization, has always viewed this modernization effort as iterative – learning and then applying lessons learned as we go. Of course, throughout all these efforts, patient safety remains our highest priority. Changing electronic health record systems and how medical personnel document patient care is a known risk, which is why the VA embeds continuous quality improvement principles in everything it does.

We understand the uncertainty innovation like this can bring, and the VA is focused on ensuring as smooth a transition as possible with minimal disruption to our veterans. More than that, we’ve demonstrated this can be done successfully. At the sites where the new system has been deployed the same great access and quality of care continues to be delivered to our veterans.

The VA’s time and attention to getting this right is paying off. On many measures, the most recent deployments at the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla and at the VA Central Ohio Healthcare System, which includes the Chalmers P. Wylie Ambulatory Care Center in Columbus, Ohio, have been successful.

Medical personnel have adopted the new records system and are using it to improve both the extent and reach of their care. Their productivity has increased, with outpatient visits trending toward pre-deployment levels. Lab personnel cite hours of work saved daily because of the new system. And importantly, leadership reports staff morale remains high.

Lessons learned from the first two sites were used to enhance every aspect of the Central Ohio deployment, including noted improvements to staff training.

By week two, for example, the system in Columbus had significantly reduced the time providers needed to document medical records, doubling their scheduled clinic appointments with 75% of their ambulatory patients being seen within 30 minutes. Additionally, their urgent care center was at or close to pre-deployment times for patients seeing a doctor, demonstrating that VA personnel there are increasingly adept at using the system.

Most importantly, veterans are effectively navigating the patient portal in the new system to better communicate with their doctors and access the care that they need, both of which are critical measures of successful adoption.

Leadership and staff in both Walla Walla and Columbus have acknowledged the positive start and expressed excitement for the opportunities the new system offers. A nurse practitioner in Columbus told us, “In terms of benefiting patient care, just being able to view outside records so easily is great!”

Neither of these two locations deployed without challenges. But like the early adopters at Mann-Grandstaff, we heard them, we learned from them, and we continue to work together to ensure a safe and usable electronic health records. Importantly, the challenges provide critical learnings to carry to the next community.

The VA remains fully committed to getting the system right – not just at Mann-Grandstaff or Walla Walla, but across the enterprise and in support of veterans everywhere. As one Marine Corps veteran in Ohio notably said, he was really pleased the new system, “will help a lot of veterans who struggle getting their records.”

Dr. Terry Adirim is the program executive director of the Electronic Health Records Modernization Integration Office for the Department of Veterans Affairs in Washington, D.C., and has worked in senior leader policy positions at the Departments of defense, Homeland Security, Health and Human Services and in academic medicine for over 25 years.