Department of Veterans Affairs Electronic Health Record Modernization
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| Department of Veterans Affairs Electronic Health Record Modernization | |
|---|---|
| Name | Department of Veterans Affairs Electronic Health Record Modernization |
| Established | 2018 |
| Jurisdiction | United States |
Department of Veterans Affairs Electronic Health Record Modernization is a multiyear federal program to replace the Department of Veterans Affairs health information system with a commercially developed electronic health record platform. The initiative seeks to align veteran care documentation with private-sector standards and to enable health information exchange among federal agencies and civilian partners. The program has drawn attention from lawmakers, technology companies, veteran service organizations, and journalistic outlets for its scale, cost, and operational challenges.
Background and Objectives
The program originated amid discussions in the United States Congress, Executive Office of the President of the United States, and among stakeholders such as the American Legion, Veterans of Foreign Wars of the United States, and the Paralyzed Veterans of America to address limitations of the VA's legacy system, the Veterans Health Information Systems and Technology Architecture (VistA). Key objectives included achieving interoperability with the Department of Defense (United States), meeting requirements under the Health Information Technology for Economic and Clinical Health Act and the 21st Century Cures Act, and improving clinical decision support, patient safety, and care coordination with entities like the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, and private health systems such as Kaiser Permanente and Mayo Clinic.
The initiative was framed within broader federal modernization efforts represented by the Federal Information Technology Acquisition Reform Act, the Office of Management and Budget, and the Government Accountability Office, with input from technology partners that serve major health systems including Cerner Corporation, Epic Systems Corporation, and Allscripts Healthcare Solutions.
Procurement and Contracting
In 2018, the VA awarded a contract to Cerner Corporation after a competitive procurement process influenced by precedents in procurement reform such as the Defense Information Systems Agency acquisitions and oversight from the Department of Justice and the Federal Trade Commission. The contract had structural similarities to large federal IT contracts like those for National Aeronautics and Space Administration projects and drew comparison to public-sector procurements such as NHS England's electronic health record programs.
Congressional scrutiny involved committees like the United States Senate Committee on Veterans' Affairs and the United States House Committee on Veterans' Affairs, with hearings that featured statements referencing accountability frameworks used by the Government Accountability Office and budget analyses by the Congressional Budget Office. Contractor obligations and contract modifications were influenced by regulations from the Federal Acquisition Regulation and oversight by the Office of Inspector General of the Department of Veterans Affairs.
Implementation and Deployment
Deployment followed a phased, site-by-site rollout model inspired by prior large-scale IT implementations including Department of Defense EHR Modernization efforts and commercial rollouts at systems such as Intermountain Healthcare and Partners HealthCare. Initial go-lives encountered operational disruptions cited in testimonies before the United States Senate Committee on Homeland Security and Governmental Affairs and reviews by the RAND Corporation.
Pilot sites included major VA medical centers comparable to institutions like Walter Reed National Military Medical Center and regional networks analogous to those of Veterans Health Administration facilities. Implementation required coordination with state health exchanges and regional referral partners such as Johns Hopkins Hospital, Cleveland Clinic, and Brigham and Women's Hospital to maintain continuity of care for veterans receiving services outside VA facilities.
Technical Architecture and Integration
The chosen commercial EHR platform emphasized modular, service-oriented architecture with components for electronic prescribing, laboratory interfaces, imaging, and clinical documentation, reflecting architectures used by Epic Systems Corporation and Cerner Corporation in civilian markets. Integration relied on standards including Health Level Seven International (HL7), Fast Healthcare Interoperability Resources (FHIR), and protocols employed by the National Institutes of Health research networks and public health reporting to the Food and Drug Administration.
The program required custom interfaces to legacy VA systems such as VistA and interfaces to DoD systems like the Defense Healthcare Management System Modernization and the Joint Legacy Viewer. Identity management and access controls aligned with federal frameworks including National Institute of Standards and Technology guidelines and authentication models used by Department of Homeland Security components.
Data Migration and Interoperability
Data migration efforts encompassed transfer of longitudinal veteran records, imaging archives, and pharmacy histories, echoing challenges documented in migrations at institutions like Mount Sinai Health System and University of California, San Francisco Medical Center. Ensuring semantic interoperability involved mapping terminologies such as SNOMED CT, LOINC, and the International Classification of Diseases used by World Health Organization workflows.
Interoperability objectives targeted bidirectional exchange with Department of Defense (United States) systems, reporting to Centers for Disease Control and Prevention, and participation in health information exchanges similar to regional networks like the Sequoia Project. Data governance and stewardship drew on models from the Office of the National Coordinator for Health Information Technology and auditing practices used by the Office of Inspector General of the Department of Veterans Affairs.
Training, Change Management, and User Experience
User training and change management efforts involved large-scale workforce education comparable to transitions at University of Pennsylvania Health System, NewYork-Presbyterian Hospital, and other academic medical centers. The VA collaborated with unions and professional groups including the American Federation of Government Employees, National Association of Veterans' Research and Education Foundations, and clinical leadership from institutions such as Stanford Health Care and Yale-New Haven Hospital to develop curricula and simulation training.
Clinician and staff feedback highlighted issues of usability and workflow alignment, prompting iteration on configuration and customization similar to post-implementation optimization efforts reported by Geisinger Health System and Massachusetts General Hospital. Patient-facing features aimed to integrate veteran access through portals analogous to MyChart and personal health record initiatives supported by the Department of Veterans Affairs.
Costs, Delays, and Program Outcomes
The program's budget and schedule experienced revisions, invoking scrutiny from fiscal institutions including the Congressional Budget Office, Government Accountability Office, and the Office of Management and Budget. Cost drivers resembled those in other megaprojects such as NHS England's National Programme for IT and large defense procurements like F-35 Lightning II acquisition programs. Outcomes measured in clinical metrics, appointment access, and patient safety were tracked by the Veterans Health Administration and evaluated in audits by the Office of Inspector General of the Department of Veterans Affairs and research by organizations such as RAND Corporation and Kaiser Family Foundation.
Ongoing assessments compare the modernization's benefits against legacy performance at VistA-era sites and legacy comparisons drawn from academic analyses at institutions including Harvard Medical School and Johns Hopkins Bloomberg School of Public Health. The program remains a prominent case study in public-sector IT modernization, acquisition policy, and health systems interoperability, attracting continued oversight from federal legislators, veteran service organizations, and healthcare informatics researchers.