An update on the VA and DoD’s new electronic health record

Since April, the Veterans Affairs and Defense Departments have been fielding what they call bi-directional health records sharing with outside healthcare provid...

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Since April, the Veterans Affairs and Defense Departments have been fielding what they call bi-directional health records sharing with outside healthcare providers. This against the backdrop of both departments developing compatible electronic health records using the same vendor – Cerner. Cerner’s Vice President of Government Services Julie Stoner joined Federal Drive with Tom Temin for an update.

Interview transcript:

Tom Temin: Ms. Stoner, good to have you on.

Julie Stoner: Good to be here. Thank you for having me.

Tom Temin: So this is really long term for both outfits – VA and DoD, I guess and Cerner, too, for that matter. Just out of curiosity, because you came up through the commercial ranks at Cerner, does it take this long for the average medical establishment to convert to a new EHR, as it does VA and DoD?

Julie Stoner: It does. It’s a large endeavor. We have commercial clients, obviously that have been through this before across the country, as well as internationally. And I’d say one of the largest lifts, and something DoD has currently completed, VA is closing in on, is really establishing what is your enterprise standard for providing care across your organization. And on the VA side, we’ve done that over nine workshops out of Kansas City, brought together hundreds of VA clinicians to really establish how does the VA provide care? What is the best practices? What is working in certain locations that can be applied across the board so that we’re really able to empower through the Cerner solution, those enterprise workflows and allow them for efficiency and safe care?

Tom Temin: And do you have the same team that is dealing with DoD and VA since their goal is – I mean, the whole point of all of this is compatibility?

Julie Stoner: Absolutely. So as a part of the latest partnership for defense health, the Cerner software is being deployed to the DoD locations. They’re actually live and a number of locations in the Pacific Northwest, Northern California. And we on the EHRM-VA side, we have a number of those associates that cross paths. Because really what we’re deploying is a longitudinal record that is hosted out of Kansas City that will provide that same solution to DoD and VA locations. For example, myself, I worked on the DoD side, led that effort for a while, before moving to the VA side. So we’re leveraging lessons learned across the board as well as because of there are so many things that are actually just joint in nature. We have associates that work on both sides there.

Tom Temin: And what did you learn from the early deployments on the DoD side in the upper Northwest Pacific? There were a couple of places where it was deployed. It took a little doing to get it up and running. As I recall, what did you learn from that?

Julie Stoner: I’d say two of the biggest lessons learned that we saw, one was around those enterprise workflows. So because we have the opportunity to bring forward a consistent way of providing care and empowering those standard processes, we found it to be really important to actually communicate out what those enterprise workflows were, ahead of the system going live. The system can support those, can empower those, can enforce those where needed. But it’s really a lot about educating those so that when the system comes along, it supports it instead of it being a whole different way of doing business on the day of go live. And that’s one thing that LPDH and the DoD has embraced in their future waves and definitely something that we’ve incorporated on the VA side. I’d say the second major lesson learned was the major effort that’s required to make sure that when we deploy this, we’re doing it in a way that is cyber secure, obviously, in the government space, DoD in particular, that’s incredibly important. And they’re actually leading the healthcare industry in this space. And so that’s one of those things that we’re able to work very closely with DoD and VA to incorporate into our now-commercial processes.

Tom Temin: And when you mentioned workflows, and so forth, the implication there is that the word “electronic health record” doesn’t really embody what it is you’re installing because it goes way deep into the clinical delivery, day-to-day services, and not just whether patient XYZ had a shot on Dec. 9.

Julie Stoner: Correct. EHRs as a whole have moved past just being a documentation system. It’s really about empowering and leading through clinical best practices so that, for example, when you have a patient that walks in with chest pains, that you’re able to immediately administer the appropriate medication, make sure that we have decisions at board in there to make sure that we’re bringing forward the right alerting or recommendations to the provider. When you come in for say, a sore throat, if you also need your immunizations for the year that we can provide that information face up so that the provider can resolve that, you know, in one visit instead of multiple visits.

Tom Temin: We’re speaking with Julie Stoner, she’s vice president of government services at Cerner. And is basically what is going into both departments, and the Coast Guard also, a commercial product that is merely being configured or is there programming going on here?

Julie Stoner: For the most part, it’s the commercial product being configured to meet the needs. The Cerner solution is highly configurable down to, you know, the units of measure on data elements and workflows. It’s really a role-based system that allows us to present the information that is needed by individual users, nurses, physicians, registration clerks, etc, so that it meets the needs of their workflow. In the space, DoD and VA – they’re certainly uniquenesses that we don’t see in the commercial space. Some of those can be solved with configuration. There are a couple areas where we’ve had to partner and innovate, change our solutions to meet those needs, but a majority of it through configuration.

Tom Temin: And so if you configure something extensively for a given situation, say VA, dealing with women veterans that have certain healthcare needs that are unique to women, versus a DoD facility taking in people that have been injured in battle – so I’m trying to think of two extreme situations. Could you have totally different configurations yet maintain data compatibility down the line?

Julie Stoner: Absolutely, because this is all in a central database, we’re able to present data and as well, and collect data the a way that meets the needs of the clinician in that setting. So, using your examples, I can capture height and weight on a female veteran who is being seen at a VA facility. And then if she goes to pick up her prescriptions at a DoD facility, that same height and weight will be present for the pharmacist dispensing the medications. It doesn’t have to move anywhere, it doesn’t have to transfer anywhere, even if it was entered in a different order where they were receiving women’s care, it would still be available in that same central location.

Tom Temin: Got it and are both departments using the same system of measurement that is metric or English, because, you know in something like surgery or the location of a screw through a pelvic bone, whether it’s in inches or millimeters would make a big deal I imagine.

Julie Stoner: Absolutely, you actually hit the nail on the head there in terms of some of the joint governance items that we’ve had to work through. There are a number of things that while we can present in a different way, whether it’s clinically relevant, etc. There are some core things that have to be decided on jointly. Units of Measure is a great example. We’ve had some long conversations on pain scales, because if I say I’m one to 10, I’m a 10 in pain, but if someone looks at it and they’re expecting to see one to 20, that’s a completely different meaning. And so some of those things really have to be decided jointly. And it’s been driving a lot of reviewing of what is the industry doing what is clinical best practices, which I really think can help move forward, the care in both departments.

Tom Temin: It sounds like both departments have had to give on some things that might have been sacrosanct before. I mean, if you had to throw cold water at someone and say, look, you got to go with millimeters here. That’s the way it goes.

Julie Stoner: There absolutely have been some tough decisions. I will say though, given the opportunity for both departments to bring some of their best practices to the table. For example, VA does a lot more rehabilitation and oncology than DoD does. DoD does a lot more trauma care than VA does. And so they instead of both having to create expertise in each of those areas, they were actually able to bring those together and say, all right, I’m going to use your content. I’m going to use your workflows because you know how to do it. And now we can just deploy that jointly.

Tom Temin: What about the Coast Guard? How do they fit into all of this because they have no records for a while, they were went back to paper after a couple of failed projects.

Julie Stoner: The Coast Guard is working very closely within the DHMSM [Defense Healthcare Management Systems Modernization] program, to deploy the same solutions that there’s a couple nuances there as to how they provide care a little bit differently, that we are looking to go live in the near future with the Coast Guard as well.

Tom Temin: And in all of these instances, it sounds like you have to have a lot of different functions and people involved before you decide on a configuration or a workflow or, say a screen presentation. How far back up the chain does it go say from the IT people implementing it?

Julie Stoner: Great question, very far. What we found is really this is not an IT project. And we look at it the same way commercially as well. The IT system can support the workflows, but really what we want to be doing is not just automating what’s there, not just documenting what’s there, but using this to drive workflows and drive best practices and ultimately, better outcomes. Because when we are able to capture this data, we can also then use that in research as to can we present you know, suicide prevention has been a huge topic as of late. Can we look at those indicators, one, use the data to develop what it what are the things that are indicators, but then when a patient comes in, and maybe they’re for something completely different, but all the indicators are there provide that intervention ahead of time – is really kind of where we’d like to see this go.

Tom Temin: I guess in the long run you could be able to really do some, I guess scholarly supportable research in trends in health issues regarding racial disparities, gender disparities, age disparities, even geographical, I imagine.

Julie Stoner: Absolutely. One of our key milestones on the VA program, which is very exciting is we’ve actually been able to take their historical data store and move it into the Cerner data center and move into our population health platform. So we’re able to start taking some of that data across the 30 years of data that was able to move in and start looking at some of those trends. So that’s effort that can start even before each site receives the electronic health care or health record. We’re able to kind of pull that data and work with VA as to how does that support their research programs? How does that better move the meter on some of those key initiatives?

Tom Temin: Sure and are some of the older VISTA people involved in this and are they on board?

Julie Stoner: We’ve had a lot of conversations in that space. The VA has such a long history of innovation, that it’s really important that we partner with the VA to move this forward. And the tools by which people will be doing research may be different. And the look and feel may be different. But really, we look at this as a partnership with the VA that they have such an important mission to carry forward. And we’re honored to be a part of that.

Tom Temin: Because there were people that were, you know, from the VISTA side that were pooh-poohing the whole thing when it was announced, but have some of them come over to be working on the project?

Julie Stoner: Yes. So through our workshops that we’ve had, over the past two years on number of design sessions, we’ve really been able to engage hundreds of VA employees to make sure that when we deploy this, it meets the needs, to your point not at just the clinician, but on the IT side, and then ultimately to support better care for the veteran.

Tom Temin: And when VA Secretary Shulkin announced this award a few years ago, I told him, it’s going to take 25 years. Will it?

Julie Stoner: That’s not the goal, no. So the initial plan is to go live in nine years and six months across the VA. The biggest lift is kind of landing that enterprise – we’re landing, what is it that we want to deploy what makes sense at all VA locations. And so we’ve been focused on that and then look forward to going live at the initial sites in the Pacific Northwest so that we can refine those workloads, make sure they really meet the needs, and then begin rolling out. But we’re looking at about 10 years.

Tom Temin: Wow. Julie Stoner is vice president of Government Services at Cerner. Thanks so much for joining me.

Julie Stoner:  Thank you.

Tom Temin: We’ll post this interview at Hear the Federal Drive on demand. Subscribe at Apple Podcasts or Podcastone.

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