The success of the Department of Veterans Affairs’ electronic health record (EHR) system rollout hinges less on the agency’s chosen vendor than on laying the proper groundwork.
Starting by shoring up the VA’s shared IT architecture and infrastructure, enabling true mobility by aligning devices to clinical workflows, and standing up integration teams are all critical.
The VA plans to deploy its new Federal Electronic Health Record to all of its medical facilities beginning mid-2026, with the goal of completing the rollout as soon as 2031. However, the agency is not historically known for disciplined technical change management. Lessons learned from commercial health care can help, and the VA can learn from the private sector’s wins to avoid predictable failures.
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Lessons From Past Electronic Health Record Deployments
CDW Government has participated in a number of large go-lives, including a regional deployment with Cerner (now Oracle Health) spanning 22 hospitals and 185 clinics — which relied on six-week iteration cycles instead of a large waterfall process. What quickly became apparent is that big health organizations need to plan for downtime, and both the VA and the Defense Health Agency are big.
Don’t underestimate contingency planning during deployments; you may need to spend weeks or even months redoing early, iterative work. Shorter iteration cycles trump “Big Bang” go-lives because the agile method allows developers to more quickly respond to problems as they arise, such as being unable to keep the system up when certain thresholds are hit.
CDW Government worked with Cerner’s technical team to examine the customer’s shared architecture and infrastructure for points of failure to ensure the IT environment was as solid as possible. This resilience mindset will avoid unplanned outages that can hurt people when their EHRs can’t be readily accessed.
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Harmonizing Mobile Devices With Clinical Workflows
Health organizations must answer a host of questions before deploying mobile devices in order to ensure they work in harmony with their clinical workflows: How do you check them in? How do you account for multiple users? How do you store them? How do you clean them in a medical environment? How do you protect them? How do you find them?
Usability is a major barrier to adoption. In examining the statistics of one rollout, CDW Government discovered nurses were leaving their mobile devices on desks or chargers. When asked why, they said the devices were one more thing they had to carry along with their electronic badges and barcode scanners.
The devices provided some alerts, but the rest of their functionality hadn’t been enabled. If you want them to stick, functions should be consolidated into fewer devices, not more specialized ones, that are made essential to core workflows. A device that fails to enable three to five functions won’t see adoption.
Mobile devices should also be easily replaceable, as they provide clinicians with something to easily reference during face-to-face interactions with patients, and their cameras and voice dictation saves valuable time while improving the patient experience.
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Incorporating Care Process Models Into the System
Modernization of network and wireless infrastructure are another consideration during EHR deployments. Clinicians must be able to move around without losing the signal, so they can quickly pull up information on patients such as prescriptions, allergies or simply who’s in what bed.
CDW Government takes organizations’ care process models and builds them into the system itself. That’s because preserving clinical workflows is far more challenging than the technology component of rollouts and should be addressed first.
To that end, CDW Government stands up labs regionally, deploying devices in a training room before hooking them up to the production system for deployment. These training rooms allow clinicians to test and confirm their workflows are preserved ahead of time.
CDW Government also employs healthcare strategists familiar with HER systems, clinicians, and their workflows and lingo — ensuring we have the clinical acumen to execute successful rollouts.
