Articles

EHRM Organization, Strategy, and Timeline Overview


Welcome to the electronic health record modernization virtual VISN road show. My name is Shilpa Patel-Teague and I work in the chief medical informatics office and my colleagues today will be introducing themselves. My name is Jill Draime. I’m the Acting Executive Director for Change Management for EHRM. Hi, my name is John Quinn. I’m with the technology and integration office and the data migration management team. The VISN EHRM road shows really are meant to be a way of sharing information about the EHRM program with facility, senior leaders and VISN senior leaders. We are going to provide a virtual executive briefing today as well as two other components, which are traditionally part of the VISN road show. We’ll have an opportunity for you to see a very high level day in the life experience, which is a demonstration of what end users will see in the Cerner Solutions, as well as we’ll have an opportunity for a high level briefing of the electronic health record capabilities from the Cerner contract. We hope you enjoy this road show. Where we’d like to start is actually grounding you in the why. We’ll be taking later about the specifics around councils and change management and data migration, but we felt it was really important to ground us in the why we’re doing this and also the why now. We had the opportunity at the end of last year to bring our VHA, OEHRM and Cerner senior leaders together to identify our why statement or our future state. So as you can see on this slide, EHRM is transforming health care for veterans, revolutionizing health care for all. Associated with that why statement are really three main tenets, which, as you can see on the slide. But certainly part of that is maintaining the quality of care and hopefully improving our quality of care moving to a modern platform. Also, we want to make sure through this process that we remove varying barriers for all of us who serve veterans and to make us all as efficient and effective as possible in the delivery of our care. And last, but certainly not least, is continuing VA’s long tradition of innovation and being leaders in the health care space. Hopefully this will resonate with you, and we’ll be providing talking points for you as senior leaders so that you can really translate this for the leaders in your facility and VISN. Next we’ll tee up a video for you so you can hear from one of our veterans directly. We’d like to introduce you to Angel. Angel’s gonna talk with you about his experience. Again to further ground us in the why we’re doing this. (upbeat music) Veterans and their families know the price of freedom, a price that can be seen inside VA medical facilities. VA is honored to serve the men and women who bravely wore our nation’s uniform. Our care teams take great pride in providing quality care to more than nine million veterans nationwide. From Palo Alto to San Antonio to Boston, at every visit, veterans expect and deserve quality care supported by the best technology. To continue delivering a high quality experience, our clinicians and staff need a modern technology platform that provides improved access to each veteran’s health record. As part of VA modernization efforts, we are modernizing our electronic health record, building on the tradition of innovation we began decades ago when we developed one of the world’s first electronic health records, VistA. We are embarking on one of the largest government transformation efforts ever undertaken, implementing a commercial, state-of-the-art, electronic health record that will deliver full interoperability with the Department of Defense and community care providers, enabling a seamless experience for veterans. Let’s hear the story of Angel Lugo’s experience in a VA medical center just last spring. Angel served more than 30 years with the United States Army. Tank gunfire and vehicle and aircraft noise from overseas tours lead to severe hearing loss. Sadly, he can’t always hear when he’s in meetings or spending time with his grandchildren. He receives DOD and VA care and recently had an audiology exam at a DOD facility. But VA had no record of that exam. So Angel had to come back for another one. I had had a hearing exam the month prior at one of the military facilities. But when I went to the VA, they did not have that on record. I told them about it, but we had to have another exam. (upbeat music) Certainly, it’s not always easy to remember everything that’s happened to you in your life. Certainly not when you served overseas. You’ve served in austere areas, served in combat. You don’t remember everything that happened, all the care that you got. You were focused on the mission. (upbeat music) The continuity of care is very significant to the quality of care that veterans receive. (upbeat music) Look, I’m a soldier for life. I know I’m gonna be needing care for the rest of my life, whether I get it in a DOD facility or I get it in a VA facility, I want it to be the best care. I want the providers, the clinicians, the physicians to have my entire record without me having to bring it up and recollect what happened in my career. Electronic health record modernization will help make experiences like Angel’s a thing of the past. No veteran should have to carry paper records between VA facilities or explain to a new doctor why they can’t receive an MRI or a certain medication. That can lead to inconsistent care and medical errors. And we cannot let that define the care our veterans receive. Electronic health record modernization will finally give VA providers seamless access to a patient’s entire health record. And electronic health record modernization will usher in a new age of health data analysis at VA. Cutting-edge analytics that will provide caregivers with actionable decision support tools to improve patient outcomes. VA’s new electronic health record will push our veteran-centric approach further, giving our providers and frontline staff immediate access to the comprehensive patient information they need, when they need it. Veterans paid the price. We have our freedom because of servicemen and women like Angel. They did their job and we are going to continue to do ours. Let the next chapter of veterans’ health care begin. (upbeat music) So we’ve talked about the why statement itself, which is the definition of our future state in this organization. We’ve heard from Angel. But let’s talk about why now. It’s often a question we get in terms of not just why are we changing but why are we changing now? Again, you can see from this slide that there are several areas of focus for us and we’ve talked about some of those in previous why slides. But anything from driving innovation, to standardization, to taxpayer savings, and quality care and veteran experience. So all of those are areas of focus for us as we transition and transform from where we are now to that desired future state. We did establish early on electronic health record modernization guiding principles. This is what guides us, all of us, no matter what role we play in our decision-making process. I’m not gonna read all of these to you. But there are a few that I will highlight in particular. You’ll notice one of these guiding principles is the flexible and open single enterprise solution. We often get asked, in many forums, the idea do we have one seamless record? And again, this is a goal and a guiding principle as we move forward with EHRM. Another is designing a veteran-centric system that enables full veteran engagement in their care. Extremely important to us as we partner with our veterans in their care. And another one I’ll highlight on this slide is standardized clinical and business processes. So again, you can see all of those that are up here, but this is what guides us as we make our decisions. The Office of Electronic Health Record Modernization, organizationally, our organizational alignment is depicted on this slide. Our office executive director, Mr. John Windom, reports directly to the Deputy Secretary of the VA. We work very, very closely with both the Office of Information Technology, OINT, and our colleagues in the Veterans’ Health Administration. Under Executive Director of OEHRM, we have three major sub-pillars. We have the technology integration office, TIO, which is currently led by Mr. John Short. We have the program management office, which is currently led by Mr. Windom. And we have the chief medical office, which is currently led by Dr. Laura Kroupa. The functions that are currently led in TIO are very similar to what is traditionally housed in the Office of Information Technology. And as such, we work very, very closely with the team in OINT. Similarly, on the CMO side, we work very closely with the Veterans’ Health Administration. On this slide, you can see our organizational structure in the CMO pillar. We have three major sub-pillars under CMO. And CMO is typically the pillar that interfaces with VHA and the field. So we have an operations pillar, which works very closely to manage the CMO operations, but also has deployment functions. In this case, we’re working very closely in the space in the Pacific Northwest, which is where initial operating capability, they’re IOC sites, are. And so there are a lot of on the ground, field-facing activities that are occurring in the deployment space. We also have the chief medical informatics office, which has a whole subsection of areas that traditionally resides with informatics and analytics as well. As you can see on the slide, we have a range of areas to include, clinical workflows, all the way to the medical-facing data migration, including nursing informatics. Also with a spectrum of VISN council planning, so a pretty wide range of different areas. And then finally, our third sub-pillar under CMO is under the deputy CMO. And we have also a wide range of areas, but primarily we have change management and quality, safety, and value. So we have a lot of interaction in the QSV space with the program offices and we work very closely with a lot of the VHA program offices in the CMO sub-pillar. One of the most common questions that we get in the EHRM space is when is my deployment window? This is a question that is on the minds of a lot of our end users as well as our field leaders. The deployment timeline that’s indicated on this slide is subject to change, but is what we know as of right now. So our IOC locations are in Puget Sound, Spokane, Washington, and with the west sea pack. So you’ll see the depiction on the left side of this slide where VISN 20 is our first VISN to be in the implementation window and the subsequent slides shows implementation starting, that have already kind of activities that already kicked off in 2018 and go all the way until the last VISN, which is currently VISN 23 and noted to begin in the 2026 timeline. We do have some overlapping VISNs. And we will of course take lessons learned from every prior VISN and apply those to the following VISN. Hi, my name is John Quinn, and I’m a VA employee from the Technology and Integration Office data migration management team. I’m gonna spend the next few minutes discussing some highlights about migrating VistA data to Cerner’s electronic health record, Millennium. As VA migrates data to Cerner and starts entering health data in Millennium, it’s really important to remember that VHA continues to own its data just like we do today. Our data migration management team has been working with the chief medical office team to identify the most important data, we call these data domains, to migrate from VistA. There’s a list of the data domains at the bottom of the slide and includes domains such as problem list, allergies, progress notes, vital signs, and radiology reports. How is VA migrating VistA data to Cerner Solutions? Let’s start by describing major components in the process. The box on the far left represents all the VistA systems and all the VistA imaging systems and operations today. There are 130 VistA systems supporting the CPRS for all of VA’s health care facilities. Focusing on VistA first, VA set up a copy for each VistA system. This realtime copy is called a shadow set and each VistA system has a shadow set located at the VA Austin information technology center. The VX130 process in the large gray box under Austin, Texas, is the VistA extract software and database the VA developed. VX130 works against the VistA shadow set only, so there’s no possibility of negatively impacting either CPRS or its associated VistA systems supporting your medical center or clinic. The truck you see in the middle of the slide, going full blast, it represents the transport of all the VistA data VX130’s been collecting. So to illustrate, we can do this with outpatient pharmacy. The VX130 is collecting outpatient pharmacy data entered in VistA from the very first record entered, you know, back in the ’90s until today. The VX130 has collected so much data that it makes better sense to make a temporary copy on an encrypted portable disk and ship it, or truck it, as the slide shows, to Cerner’s Kansas City data center. The portable disk of VHA’s data will be restored to the Kansas City VX130 system. And then Austin VX130 and Kansas City VX130 will stay in synchronization as the Austin VX130 captures data changes. These are inserts, deletes, updates, basically using CPRS made in VistA and sends those new and changed data to Kansas City. The next important step is for VA to send the VX130 data to Cerner HealtheIntent through a service identified on the Cerner HealtheIntent box. The Cerner team will then transform and normalize the VistA data from all 130 VistA systems into one patient longitudinal record. As each VA medical center nears their go-live date for Cerner Millennium, Cerner staff will migrate your patients’ data from HealtheIntent to Millennium. Although I’ve been discussing VistA data migration to Cerner, it’s important to note that VA’s also asked Cerner to export data from Cerner to CDW, the corporate data warehouse, for VHA’s reporting, analytics, and research requirements. For imaging migration, which is on the bottom of the slide, Cerner will migrate radiology and diagnostic images currently stored in VistA Imaging to Cerner’s vendor-neutral archive platform which is known as Care Aware Multimedia, or CAMM. To summarize, VA is migrating data to Cerner to ensure veterans do not have to retell their story as VA transitions from CPRS to Cerner Millennium. This slide shows average site implementation. It’s really what happens when we, in the ERHM team, get to your facility. On the left side of the slide you’ll see we usually kick off with a site briefing. That’s when our team will meet with the executive leadership team at your facility and talk about the events of the upcoming average of 18 month window. We have a series of events that are happening, one-time events if you will, that are happening right now at the IOC sites. We had a model validation event that occurred in August of 2018. And we had national workshops begin in the fall of 2018. And so those events will not repeat, but this slide just shows what we’re currently working with as our timeline with the IOC sites. Many of the events that you’ll see towards the middle of the slide is really what will be replicated at every site. So for example, there will be several change agent sessions and super users launches. And typically, as I mentioned, the window from kickoff at the site briefing to go live will be about 18 months. Our Cerner team, as well as our office, will guide the facilities through every step of the way. And during this time period, it’s crucial to work with your facility’s change leadership team, which Jill will mention in a subsequent slide. This slide really designing the future state is summarizing the work that’s currently occurring in the national councils space. So we have 18 national councils that cover the different areas that you see on the screen. We have it divided up under three major categories of clinical, ancillary, and business support services. The national councils really exist to define what the enterprise-wide workflow standard will be and we are adopting commercial workflows for the most part. But in our VA space, we know there are certain nuances that we want to incorporate in our end user experience. So really those conversations happen at the national council level. Our chair folks of the national councils are, in many cases, program office leads as well as some field experts, and we’ll talk about them in a subsequent slide. The majority of the decisions are being made in the national councils. However, based on every VISN and every facility, there will be opportunities for discussion on perhaps meeting those regional regulations. And those discussions, that might be dependent on staffing variances and such, which comes the VISN space. So we do have VISN councils that we’re currently in this, working with the VISN 20 team on establishing. Those VISN councils mirror the national councils and are really built to help with those facilitating those discussions that are specific to every VISN. Also, there are activities that are happening at the facility level. There are local workshops that occur. And at those local workshops, there’s education and some local decision-making. For some reason if there’s a deviation that needs to occur from the national standard, those recommendations can come from the facility via the local workshops. And so roughly 10% of the decisions we expect to be made at that facility level. It really is that last mile integration where the minor configuration items are coordinated with each facility. And again, it’s very important that work with your facility leadership team as you’ve designated via our EHRM liaisons and our change management team to determine what those deviations may be. Our national councils really are composed of both a good mix of field and central office representatives. I’m really happy to say that a lot of the work that we’re doing is really a nice balance between that field and national members. As an example, a lot of our national program office leads are either council chairs or representatives on our national councils. So we are working in close collaboration with those offices. We do have representation from every VISN on our national councils. Also, we are working very, very closely with Cerner as experts to give us guidance on the decisions that we’re making and having facilitating those discussions at our national councils. And as I mentioned earlier, we have structures currently established beyond the national councils at the VISN council level and discussions that are facilitated at the local workshops to occur if there are decisions that need to be escalated and specific to a specific area. But also, in between the national councils, if we don’t have resolution and we need to have a discussion with executive leadership either in EHRM or in VHA, we have a governance structure that national council decisions can be escalated to. We have interdisciplinary members on the councils. And so we have a variation of disciplines that are also a part of our national councils. You can access a link in this PowerPoint to see who from your facility or VISN may be a member of our national council, either as a member, chair, or consultant. This slide shows currently our 18 national council chairpersons and the number of members each national council has. We also have consultants and again, the time commitment for these members and consultants can vary, but it is a pretty significant time commitment that requires a memorandum of understanding with each facility leadership, and/or VISN leadership team, to have a member of their staff participate in our national councils. One of the most frequent questions our office gets is, how will the EHRM implementation impact veteran access? And our offices realizes with any commercial EHR implementation that access is typically something that is a factor. And we have, from the get go, realized that and partnered with a number of VHA program offices to determine what things we can discuss now to help those conversations and discuss strategies for mitigation. We are partnering currently with the Office of Connected Care, the Office of Community Care, the OVAC office, the access office, Office of Primary Care, and other leaders, particularly in our IOC sites in VISN 20, to talk about what the impact will be on things like staffing, productivity, scheduling. As we train our staff, what kind of impact will there be on provider workload and impact to their schedules as they typically would be seeing patients. And so we are looking at a number of areas and discussing this. We’re having conversations about possible scheduling modifications that might need to be met, made. Also looking at interim staffing conversations, telehealth solutions. And so really working through this. It’s a work in progress, but wanted to make sure you were aware that this is something that is on our radar and we are working with a group to work through solutions so that as any VISN is in their implementation window and during their go live period of time, we have strategies to propose and assess to minimize veteran access impact. There are a few areas I’d like to highlight on this slide. But let me do some level setting first in terms of what we mean when we talk about change management. I did not realize that change management has different definitions. So let me define it here so that we’re all speaking the same language. So from our perspective, change management is a structured process and set of tools for leading the people side of change. The intention, when you lead this people side of change, is toward a desired outcome and from an ERHM perspective, that desired outcome is successful user adoption. So just wanted to make sure we’re all on the same page in terms of what we mean when we say change management. We have adopted, inside VA, the Prosci methodology for change management, and as you can see here, there are five sort of stages associated with this methodology. Oftentimes what we do when we talk about, start to implement around change management, is we go directly to training or, and you see on this slide, the knowledge component. But as you notice, there are two areas in front of, or before, knowledge or the training component and that’s awareness and desire. Part of that awareness building we’ve already talked about in this virtual road show, which is the why. So we really want to start with grounding all of us in the why that we’re doing this and the potential benefits. But it really is the vision, or the future state. And just making sure you as leaders and the staff are aware of what electronic health record modernization is as well as the why we’re doing this. And then we also wanna do some desire building, which is to get people excited about the prospect of what EHRM will bring us. And oftentimes answer one of the biggest questions for staff, which is, what is this gonna mean to me? What’s the impact to me? So through this road show, as well as other activities, we want to equip you as senior leaders to be able to talk with staff, make the translation for staff, and interact and engage staff with what’s to come in terms of EHRM. Shilpa mentioned earlier what we call the change leadership team. So I want to talk a little bit here about those three roles and what the function is of change leadership team, both at the VISN and facility level. So you will see the change leadership team is made up of three roles. First is executive sponsor. If you look at any change management literature, one of the most important components is sponsorship or leadership. So both at the VISN level and at the facility level, we require that the individual who is in the executive sponsor role be from the executive leadership team. So this is not about delegating leadership or sponsorship. This happens at the executive leadership team level. The change lead is such an important role in addition to the sponsor and the coordinator. This is the individual who really leads the change effort. We have made the decision inside of VA between OEHRM, VHA, and OINT leadership that the face of change management is VA. This is not a delegated responsibility to anyone else outside of VA. So we insist that all these three roles be VA employees. And again, really the change lead is often the face of that change for our facilities and for the VISN. And then the change coordinator is really a partner in all of this, with the change lead in particular, but in support of the executive sponsor, to really help with the day-to-day execution of the change management strategy and plan. So this person, again, is a critical role. The change coordinator has a dual hat role. So they are at the linkage between change management and deployment. So again, they really help bridge that gap between what’s happening locally, in terms of deployment activities, and change management. Now, I’m sure you have been paying very close attention during this virtual road show. But if you have started to multitask, which again I’m sure you have not, I want to draw your attention back to us because the next couple slides are ones you’ll want to pay particular attention to. So as of January 2019, on the next three slides, you will see who has been identified as the VISN executive sponsor, change lead, and change coordinator. And you will also, there is a corresponding executive sponsor, change lead, and change coordinator for every facility. So again, executive sponsor is someone out of the executive leadership team. Change lead, we are finding with our IOC sites that typically having somebody with some clinical background and experience is very helpful; not necessary, but tends to be very helpful. So we would ask every VISN and facility leader to stay connected with who your VISN and facility change leadership team are. They’re getting lots of information on a regular basis. We have a monthly community of practice call for our VISN change leadership team where we cover all kinds of things that are happening in the change management world, communications, CMIO, all kinds of, deployment. So all kind of areas that we cover and share lots of information. So these folks are an incredible resource in what’s going on in the EHRM space. One of the things that we thought would be very helpful. You know these road shows are incredibly helpful in grounding us in terms of what’s happening with EHRM. But again, we wanna equip those change leadership teams to be able to be an extension of the change. So we’ve done a couple things to try to do that. One is, prior to all of the VISN road shows where we’re going out VISN by VISN, is making sure, prior to that that the change leadership team feels equipped and ready in terms of what’s coming. So we’ve been calling those awareness briefings. We conduct the road show at the VISN. And then post the VISN road show, have an awareness briefing, partnered with the change leadership team, for our managers and supervisors. Our managers and supervisors are an incredibly important component of awareness and desire building in our facilities and in the VISN. So what we don’t want to have happen. Maybe I should state it in terms of the positive. What we do want to have happen is we want our managers and supervisors, if a staff member comes to them and said, “I’m starting “to hear about his EHRM thing and Cerner, “and what is this and how is this gonna impact me?” We want our supervisors and managers to be equipped to say, “I know what that is, “and here’s what I can tell you now, “and here’s how I know where we can go “to get additional information.” So as much possible, we’re trying to equip our supervisors to be that voice. And our employees can go to them and know that they’ll get accurate information. Let me transition briefly to talk about training. I know that that is on people’s mind in terms of what that’s gonna look like and what does that entail. So let me talk just a little bit in terms of how that’s gonna look from our perspective as we know now. So we do have end users. So anybody who’s gonna touch EHRM is considered an end user. I’m not gonna go into detail about super users today, but just make reference to super users. Super users are, in the Cerner world, are very similar to what they are in VA world currently. So they’re individuals who have both enhanced training experience who can support pre go live, go live, and post go live at our facilities, but also they tend to be kind of early adopters of technology and excited, highly respected individuals who can help our staff through this process as we move to EHRM. And the last are providers. There’ll be additional time and attention to our providers in terms of training so that we make sure that they feel prepped and ready once we go live. There will be a blend of a training approach. Some CBTs, or computer-based training, but the majority of our training happens as instructor-led training, and also self-paced training, which allows open lab time where our employees, our end users, can come in and practice, proctored by both Cerner staff and super users, and have the opportunity to go through scenarios based on their particular role. I’m gonna talk on the next slide about what the learning model looks like in terms of graduated levels of training. So let’s transition to that slide. I always find it helpful to have an example. So, we’ll take the example of somebody who would be a nurse in one of our VA MCs. So at the 100 level, this is pretty consistent for everybody. It’s the foundations of why, why we’re doing this. This is delivered by computer-based training and just gets all of us anchored and grounded in what this is and what’s to come. At the 200 level, if I were a nurse, again, majority of this will be instructor-led. And this is just gonna give me the foundations of what the solution looks like. Does not matter where I practice nursing in the facility, that doesn’t matter, that’ll come in the 300 level courses, but this is the opportunity to understand sort of the functionality. We get into workflows and specifics when we get to the 300 level courses. So you’ll notice now at the 300 level, we’re into specialty workflows. This is where, if I’m in the ICU or if I’m in the ED or if I’m on the MedSurg floor, what my life looks like varies depending upon that role. So we take the time, through our end user training, to really help our staff with the specific role that the have, the specific workflows that apply to them. As I mentioned before, at the 400 level, this is open lab, self-paced learning, taking our staff through scenarios that help them to really put into practice what they’ve learned in the instructor-led training. Often get the question, what does end user training look like? When does it happen? So on this slide, you can start to get a sense of when we started rolling our staff into training, when we start some of the 100 level courses, when super user training comes along. But most people notice on this slide that end user training takes place starting seven weeks prior to go-live. So no matter how many employees you have in your respective facility, you’ll be sending those employees through end user training really close to our go-live time. Again, mostly the question we get is how exactly am I going to do that? We’ll work closely with you as leaders to do that. But the idea is that we can’t teach and train our staff six months prior to go-live and then expect them to have retained that when it’s time. So as close to possible to the go-live time, that’s when end user training takes place. And last in the training space, let me talk about our VA Innovative Technology Advancement Lab, or VITAL. Unlike end user training, which, if you touch the electronic health record modernization system, you will receive end user training specific to your role, VITAL is really intended to be graduate level, specific training for many of our functions in the facilities, but it is really targeted specifically to our informatics and analytics community to really give them the knowledge and skills that they need to optimize the capabilities. So beyond getting end user training and understanding how to use the system so that you can perform your day-to-day job, which is incredibly important, we need to train a cadre of staff at each of our facilities to be able to optimize the system that we’ve purchased. So you’ll notice here there are four sessions taking place over a span of time. Session one and session two taking place prior to go-live, and session three and session four after go-live. We want our VITAL participants to have had end user training when they really start to learn to optimize the system. There are virtual checkpoints all along the way. And we’re really creating a community for those who we send through this training and who have the skills and experience that we need to optimize the system moving forward. It’s really important that we provide you with some areas and locations and regular cadences of when we can connect with you and you can hear frequent updates about the EHRM efforts. At the National Leadership Council, frequently, almost monthly, EHRM updates are provided. And so the network director team, as well as several program office directors, are kept abreast of the latest with the EHRM program. The VISN Chief Health Informatics Subcommittee, the VCHI group, is one area that is near and dear to my heart. I’ve been the co-chair for the past five years. And that’s an area for sure that we frequently talk about EHRM updates, particularly in the space of informatics and analytics. The Field Health Informatics Council is a monthly forum where a lot of your informatics and analytics leaders frequently attend. And there are periodic updates on those calls. The Clinical Application, CAC, and Health Informatics Specialists calls nationally are held monthly, and another location where regular updates are given. As Jill mentioned, we have EHRM VISN COP calls where all of the VISN executive sponsors and the change leadership team members attend, and you know really the best forum to hear updates, the full spectrum of areas in our office. And in many VISNs have established EHRM-specific calls to determine what they can do now, regardless of where they are in the EHRM deployment window. There is certainly activity that can occur now in preparation of EHRM deployment. Areas that we really haven’t had a chance to cover today that I really wanted to briefly touch on is that our office continues to work very, very closely with the Department of Defense. And so we are working with them and taking lessons learned from their experiences with their EHR deployment and applying those and conversing on impact in the VA. Probably the most frequent question we get is, what are the staff responsibilities for my team members in informatics and analytics and how will that change? We are having conversations with our Cerner colleagues in that space right now and so we are focusing our efforts primarily in the efforts of informatics. So the clinical application coordinator, how their functions may change. The most common question I get is, will we have a need for the CACs in the future? And the answer is yes. We do not expect any CAC to lose their job. However, their role may change. And so really defining what that change looks like is what our efforts are focusing in on. And we will follow up with some of the analytics roles that frequently reside at the medical center as well. Other locations where you can find information about our program: Our intranet site is listed here, we have internet site, as well as a mail group, the OEHRM questions mail group, where you can send your questions specific to your facility, VISN, anything you might ponder upon, you can send or utilize any of these resources. They are frequently being updated, so feel free to use those. What can the facility and VISN leaders do to support EHRM? All of you have a very unique role and our successes of change really rely on you as a leader and how we can work together to make this implementation very successful. As executive leaders, you’re responsible for championing the effort and the vision of the EHRM initiative throughout your respective facility and VISN. And so we recognize that your staff really do want to hear certain messages and information from you as you set the tone for the transformation. And this truly is a massive transformation. You will see in the demonstration that accompanies the virtual road show that there are literally impacts in almost every area in your hospital operations. And so with this massive transformation, we really need your support to set the tone and help cascade the messages that we’re trying to deliver today in this road show. You know your VISN and facility best, so you can help us with anticipating those areas of resistance and negativity and let us help you get in front of that. So by conversing with our team and giving us that feedback, we can help you with helping us in our initiative together. And we know that every VISN and facility is a little different. So again, we’re here to support you and work with you on how to best support your respective implementation. Really our call to action in our last slide we wanted to touch on today is, as executive leaders, you really are critical to the process. As far as EHRM updates go, staff should know that they can come to you for the change. So we would appreciate if you could take the key messages from this presentation today and speak to the massive transformation that our organization is embarking on with this transformation and let them know that you are supportive of this change. We talked about a lot of reasons why our office and the VA has chose to set upon this journey and we talked about that why story and hearing Angel’s experience earlier today hopefully conveyed that. But let us know how we can help tailor the message with your personal endorsement to, depending on the audience, to make sure that they understand how the EHRM initiative really impacts their space and what is the why and make it applicable for them. Another area that we feel very important upon about how we can elevate the awareness of EHRM initiatives is by adding EHRM as a standing talking point on your agendas in meetings that you hold with your leaders. So just keeping it on the radar every month or quarter. Having the discussion at your VISN executive leadership committee, as an example, is a practice that a lot of network directors have taken where they have their executive sponsor and change leadership team routinely give updates to other leaders on what developments the EHRM has for that respective VISN is something that we’ve seen as a best practice. And so you know just having that on the agenda and reminding folks that you know again, there are things that can be done now, is something that we feel like you can all assist us with as executive leaders. Our goal really is to have every person on site understand why we are modernizing our EHR and really what’s expected of them before the go-live implementation. Our office and our efforts cannot be successful without you. So we really want to thank you for your attention today. We hope this executive briefing was helpful as well as the other components of the road show. We look forward to collaborations with you as leaders on our journey forward together with the EHRM implementation in VA. Thank you.

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