The Million Patient Migration

Welcome to the DAV podcast. I'm Todd Hunter. We're diving straight into one of the largest modernization efforts in federal health care, the Department of Veterans Affairs electronic health record deployment. Joining us in the studio is VA Deputy Secretary Paul Lawrence to discuss leadership, standardized care, and what these updates mean for veterans on the ground. Let's get right to it. Thanks for coming by today. >> Thanks, Todd. Thanks for having us. >> Absolutely. So, uh, the successful rollout of the EHR in Michigan was a major milestone for the VA. Uh, and there's scheduled deployments in Ohio, Indiana, and Alaska, uh, through 2026. Coming out of the previous, uh, deployment pauses, what has changed structurally, uh, that has allowed VA to get this massive modernization effort back on track? >> Um, well, handful of things. Perhaps most importantly is what we refer to as intentional leadership. The secretary was very clear from the moment he went to his confirmation hearing that we're going to do this. It's an incredibly important project, and all the conversation about what's taking place at VA, we're missing the obvious fact, which is everybody has electronic health record, state-of-the-art technology, but us. And he said something on the order of, "We're special, but not unique. We should be able to do this." And that was his intentions. So, for the month before I showed up after he got in office, he convened our contractors, our staff, and said, "This is what we're going to do. Come up with a plan." Which resulted in the 13 going live in '26, '26 going in '27, and so on, building up to the schedule in 2031. From that came a series of things. Strong leadership, that would be me, uh, accountable by law, accountable by law as well as person the secretary pointed to to go deal with that. Two was secretary's focus on standardization. Too much had been everybody customizing before and changing the work in the software, which is not how you get to take advantage of a sort of an enterprise approach, bear with me. And so we said, "No, you're going to do the medicine that's described in the software." So we've really been tough on that. I think it's really coming to appreciate the strong leadership we have at the medical centers. They really kind of make it all happen. And so I spent a lot of time going there. In Ohio, for example, I went to every site twice to talk to them in detail about the work they were doing. And perhaps most important, listen to their concerns to make sure we were dealing with them. So a whole series of things, backed by strong work from our team, from our IT people and the like. But those were probably the difference the differences. Okay. So any major software transition like this, it's obviously it's going to have a learning curve, right? Um but when you go to these go-live sites and speak to the local staff, what are they telling you about the transition? So the transition doesn't bother them so much. Many people have transitioned before elsewhere. Not all of them work with VA forever. They've gone through transitions. When they came to VA, they generally had a transition into a new software because no one has what we have now cuz it's our own homegrown software. But they wanted sort of two things. Well, three things. Reassurance it's all going to happen cuz of course as you know from the previous administration, they stopped and started and paused and reset and pulled the rug out from people just when they were getting ready to go live. So they were really concerned about, "Are you going to go live?" So you had to reassure them. "Will you give me sufficient training that I'll be aware of what needs to be done?" So our training is really very good. Starts with computer-based training, they'll let them play in the sandbox, kind of look and feel stuff. And then we give you a learning library you see it all. And finally, and this has been the differentiator and really positive feedback from India and from uh Michigan and Ohio, is what we call at the elbow support. People who have used the system are with you for the first 2 weeks helping you work through stuff like, "Oh, where do I click again? How does this really work?" That's been invaluable. And so, as we get more people exposed to the system, now the Michigan people were helping Ohio last weekend. When it comes time to go to Indiana, Michigan and Ohio will help them and all their friends. And finally, something that I realized but I didn't see it play out before. It's like everybody in VA talks to all their friends. So, already, you know, the different the different skill sets make this up. Could make this up. The cardiologists in Ohio already were talking to the cardiologist how does it in Michigan. How does this work? Explain to me. Folks in Indiana are already calling all their friends and saying, "How does it So, a lot of informal knowledge sharing is taking place as well. So, they're getting a lot of information as well as a lot of help. Okay. >> And and so, what is the department doing to ensure that this implementation doesn't temporarily pull the focus of everyone away from direct patient care? >> Certainly. Well, two things. We have a schedule cuz we know you know, life has a learning curve, right? So, what we call we call it ramp down, ramp up. We will slowly decrease the appointments you have as you prepare and then slowly we'll slowly reintroduce the appointments so as you build up, right? And the the the metric we look for is getting to pre-deployment levels of productivity. That's what we're seeking to do. So, when you're ramp when we're ramping down, we realize you we can delay your appointment or we can send you into the community. We have that option as you know. So, that's been a lot of community care. We're paying a lot of attention to ramp up because of course we know many many people want VA direct care. So, so far what we've seen is folks are ramping up faster than we had estimated. So, in fact, in some places, they're so confident they don't even want to ramp down. They're like, "We know how to do this. We don't think this will be a problem." So, we know this is something our veterans tell us, "Get us back into the the appointments in the places we want." So, we have a lot of mitigation. I'm not that's our plan. Okay. >> Now, and so the ultimate purpose of the EHR is this seamless interoperability meaning someone goes from active duty, their records go straight to the VA, and VA can even go straight into the community care network with those records. So, for a veteran who's watching right now, what does this new system look like in practice for them? >> Well, ideally they should see nothing, okay? Basically Basically a doctor sitting behind a computer much like he or she was before. >> Yep. >> He should see nothing. Now, you see a lot of signs in the hospital telling folks this is coming, so they're prepared for this. The first appointment we'll spend a little bit longer with you to make sure all your medicines transferred correctly, and we got the right or things going on. That was some of the feedback from some of the hiccups before, but generally that's that's worked really, really well. We're really good now at transferring prescriptions. We do about a million every week in when we get ready to go live. So, that's going well. What we're hearing from veterans who are using it before is sort of the ease of engaging with us. It's easier for me to direct message my provider. It's easier for me to order my prescriptions online, and I'm more comf- comfortable that all my information transfers when I go into the community. I used to have to carry your records by paper. It's all there. We've heard that feed. So, theoretically not nothing, but what they should experience though, and this is the really magic, is the provider spending a lot more time looking and talking to them, looking at the as opposed to looking through the computer to find information, you know, look for stuff, copy, paste, do whatever. That's really our goal to get the providers to practice medicine, which is why they came to us to begin with. >> can be frustrating when you're there, you provide an answer, and you hear someone click the mouse 20 times before they uh ask another question. >> Or tell the history, you know, how many times do I have to tell you 20 years ago I hurt my back at airborne school. Like why are like why don't you know that, right? That's the feedback, and we understand that, and so that should go away. >> Okay. And so, how does it reduce the burden on them to prove their medical history and and avoid duplicate testing and and labs, all that kind >> Well, hopefully they don't have to prove their medical history cuz it's all right there. They're all right there. So, they don't have to go, "Hey, really was that you know, did that really happen?" Yes, yes, yes, look, it's all right there. So, that'll go away. The the the duplicate labs and extra tests is something we're really excited about, right? Because you could imagine you show up and say, "Hey, did you do that test?" Yes. Okay, it's not here. Let me send you again. And that was a very common thing. Early data from Michigan shows that the number of tests we're ordering is less than same time last year. So, it's very, very positive, and we don't want to order extra tests. It's expensive and nobody likes it. So, that's our goal is to reduce that as low as possible. >> All right. And kind of revisiting some you touched on it a little bit earlier, but in the past, the EHR rollout has faced challenges with the kind of fragmented decision-making and localized uh customization kind of is what caused delays. And the VA is You guys had since streamlined that so that there is a single council that answers directly to leadership. So, moving forward with the goal to department-wide deployment by 2031, my understanding, how is this new governance structure uh keeping the the vendor partners accountable to patient safety and customer service timelines? >> Certainly. Well, you're being charitable. We have stopped all that. Okay? No more customization, no more everybody gets to do their own thing. Those days are over. We know that's key. Okay? Minor exceptions, but that has stopped. We have a very tight governance process, one council. I am in charge of that. Any decisions are appealed to me. We know exactly what needs to be done. And kind of have context for this. This record exists and it works in the private sector. We don't have to reinvent things. We have to focus on what the secretary said, provide great care to our veterans, not have an unbelievable dance inside our building about how we're going to do that. We've got to get this working and most importantly, we've got to get it adopted by our providers cuz we think this will just make it easier, perhaps faster, but better for them. So, that's our intention. So, we want the governance and the management of this process made, you know, incredibly efficient. And as we do this more and more, there should be fewer and fewer decisions. How we're doing stuff, once it gets resolved in Michigan, fine-tuned in Ohio, it's going to how it's going to be in Indiana. So, the only thing we pay attention to a great deal is what we call VA firsts, the first time it's happening in the software, right? So, in Michigan, there was a research in Ann Arbor. In Indiana, there is trauma centers. Like, so we know that's where we got to pay attention, understand? But once those are all done, then it's just a matter of kind of getting it going. Not a trivial thing, but it's but it's more straightforward and requires a whole lot less, you know, decision-making and conversation about what right looks like. Okay. >> Uh so far today, we've talked about Michigan, Indiana, Ohio, Alaska, but uh there's 164 medical centers uh that this the EHRs is going to nationwide. As the VA continues its rollout in the 2031, what role do you see veteran service organizations like DAV having in the process? >> Well, we need your help. We need our veterans to understand this change is coming and while we made a big deal about it, be comforted knowing it shouldn't have much effect if only positive information, no more records. Um if you do stuff like live one place and go somewhere else, have to come see us, you know, a classic example Michigan, I went to I I I vacationed in Florida, what happens to me? You go there, the records didn't transfer, we had to call, you had to call, bring them by paper. All that's going away, it'll all be there for you. But it's also a good news story that we want folks to hear, which is too often and this was pre-Michigan when I'd say, "This is going to work." They're like, "This never work. You you always come up short." This is an example of us not. And why it matters is our goal is to deliver world-class health care to our veterans. To do that, we need top tools, and this is it. And what's really exciting to think about is what the future's going to offer, right? With a world-class health record, right? Cool stuff that's coming. AI, advanced technology, and stuff. We can hook it up and use it. So, what we're going to be able to offer our veterans in terms of care in the future is exponentially better than where we sit now. So, I would say, "Understand the change. Tell folks it's coming. Tell them it is a good thing cuz it really is." And again, this is an example of VA listening and following through on what we promised. >> I'd also tell them to make sure that they vacation in Florida. That's very important. >> Yeah. Yeah. That's good. And and you'll get health care. Or if you go to Arizona for the winter if you're a snowbird, you'll be able to get care there, too. >> Or Colorado for the disabled veteran. >> There you go. There you go. There >> So, a recent GAO report highlighted that this effort kind of lacks a unified framework to protect patient data. And given how cybersecurity disruptions can directly impact veterans' medical care, what steps is the VA taking to ensure that these cybersecurity gaps are closed? >> Yeah. So, to to go into the weeds on this report is to appreciate it, right? So, what it talks about is VA coordinating with DoD, Coast Guard, and the like to have a collaborative approach to this. So, that's hard to do. We welcome all GAO advice on how we do that. So, we work closely with them cuz as you pointed out, the record's supposed to exchange information from DoD and VA. So, a lot of collaboration takes place. So, they're encouraging us to do more of that, and we agree, and we spend a non-trivial amount of time talking to them around these things. But what it doesn't But what it complements though, is our work with cybersecurity. VA has a great layer through the information technology department stuff that we do. And then Oracle, the provider, has a great lay layer of cybersecurity. So, it is safe. Veterans information is safe. This report encourages us to do more jointly with the other organizations and and we agree and and we generally follow the recommendations. >> Just want to open up the floor. Anything else that you'd like our audience to know about what VA is doing with this massive modernization effort? >> Yeah, um it's really it's really a good news story in terms of getting things started again. I think everybody was frustrated from afar that, you know, the commitment to give veterans care to use old tools and the like not only affected veterans, but I quite frankly, it affected our ability to attract providers. Why would I come to VA and use tools that nobody else is using? And then at another level, something for you all to think about. We talk a lot about technology. This is really a people project, right? Our goal is to get veterans care, right? To the individuals and knowing that, you know, hey, we're giving you great care and the tools are helping us not preventing us. We don't need workarounds and the like. So, you know, that's something we're proud of. And the other sort of thing is like, you know, this is a continuation of the promises President Trump said in motion. We're going to restart the healthcare record, done. We're going to lower the claims backlog, done. We're going to open more clinics. We've opened 36 clinics in the last year to get you access to care. We're going to give you appointments during the non-regular business hours. We're doing that. We're going to eliminate veteran homelessness and last year we housed 52,000 veterans, the most in 7 years. So, this is a continuation of completing the promises we made to our veterans. >> Great. Thank Really want to thank you for coming in today and and speaking with us about this. >> No, I appreciate appreciate interest. Thank you for what you do, too. >> Deputy Secretary Loren, thank you so much for coming by and sharing these critical updates with our audience. To stay up-to-date on the latest news, benefits, and health care developments impacting our nation's veterans, make sure to like, subscribe, and share this episode. Thanks for watching. We'll see you next time.