VA/DOD Joint Governance Board Ensures Federal EHR Changes Benefit All

Originally published in the Department of Veterans Affairs (VA) Electronic Health Record Modernization Navigator

The Federal electronic health record (EHR) is shared by VA, the Department of Defense (DOD), the Department of Homeland Security’s U.S. Coast Guard (USCG), and the Department of Commerce’s National Oceanic and Atmospheric Administration (NOAA). To meet the needs of the different sizes and “shapes” of health care organizations and keep pace with advances in medical care, the Federal EHR was developed to be highly configurable. However, sharing a single, common medical record means the system must be governed in a joint manner. When configuration changes are requested that will affect all users across all sites, the Joint Sustainment and Adoption Board (JSaAB) is the final governance body that ensures the change will benefit end users and avoid any negative impact to the partner organizations.

The JSaAB operates within the Federal Electronic Health Record Modernization (FEHRM) office. The FEHRM’s charter states that its primary mission is to implement a common Federal EHR to enhance patient care and provider effectiveness wherever care is provided. This positions the FEHRM as the functional leader and collaborator of choice for all Federal EHR partners in the drive toward an optimized user experience and enterprise convergence. The FEHRM facilitates joint concurrence and ensures the baseline of the Federal EHR is as stable as possible—the JSaAB is just one of many vital governance forums within the FEHRM that helps VA, DOD, and other federal partners make decisions pertaining to functional content and configuration of the system.

The JSaAB makes sure change requests are evaluated to determine their impact on the health care operations of each Federal EHR partner organization. Changes can be requested by end users and leadership at VA or DOD facilities or by DOD and Veterans Health Administration clinical and business communities.

The JSaAB is co-chaired by one programmatic and one functional representative from DOD and VA (four co-chairs in total, with USCG and NOAA represented by the DOD co-chairs). The group meets every Wednesday and approves approximately 30 to 40 changes in each meeting. When a new facility goes live with the Federal EHR, the JSaAB convenes daily during deployment to review any changes that may be unique to that site. The JSaAB also has processes in place for emergency review and approval of changes when a potential patient safety risk is identified.

Change requests are received from various areas within VA and DOD, both at facilities currently using the Federal EHR and from informatics staff within each organization’s centralized program management offices. The FEHRM’s JSaAB governance is set up such that, regardless of how an individual department processes a change request, they filter up to a solution team within the Defense Health Agency Health Informatics group or the VA Electronic Health Record Modernization Integration Office. Once the solution team determines that a change is needed, there is a robust, department-agnostic process to review, test, approve, communicate, and release the change at the enterprise level.

Once a request enters the JSaAB process, it first goes to one or more clinical and functional specialists within VA and DOD for review and concurrence. Federal working groups (FWGs) are chartered under the JSaAB and provide advisory, process, and operational support to drive convergence of EHR configuration across the federal partners and maintain the Federal EHR baseline. There are currently 15 FWGs that provide VA/DOD subject matter expert consultation on change requests.

FWGs offer several advantages, especially in the context of managing and configuring the Federal EHR:

1. Expertise and specialization:?FWGs bring together subject matter experts from various fields within VA and DOD. This ensures that decisions are informed by the latest knowledge and best practices in health care and technology.
2. Collaboration and coordination:?These groups facilitate collaboration between different federal agencies, ensuring that changes to the Federal EHR are coordinated well and meet the needs of all stakeholders. This helps in maintaining a unified approach and avoiding duplication of efforts.
3. Efficiency in decision making:?By having dedicated groups focused on specific areas, FWGs can streamline the decision-making process. This allows for quicker responses to change requests and more efficient implementation of updates.
4. Consistency and standardization:?FWGs help maintain a consistent and standardized approach to Federal EHR configuration across all federal partners. This is crucial for ensuring that the system works seamlessly across different sites and for different users.
5. Enhanced problem solving:?With diverse expertise and perspectives, FWGs are better equipped to identify and solve complex problems. This collaborative approach can lead to more innovative and effective solutions.
6. Support for change management:?FWGs provide advisory, process, and operational support, which is essential for managing the lifecycle of change requests. This support helps in ensuring that changes are implemented smoothly and effectively.
7. Focus on user needs:?By involving end users in the process, FWGs ensure that Federal EHR configurations meet the actual needs of health care providers. This user-centric approach enhances the usability and effectiveness of the system.

In addition to FWGs, most change requests are also evaluated by various clinical councils and/or clinical communities within VA and DOD to obtain guidance and direction from subject matter experts within any potentially affected clinical specialty

When a change is ready for the JSaAB, the FEHRM conducts a quality control analysis to ensure that process requirements are met and all documentation is present. Before the weekly JSaAB meeting, the co-chairs review each proposed change and evaluate the functional or programmatic impact from both the VA and DOD perspective. Change approval notifications are then sent to the implementer, and VA and DOD each hold a User Impact Series meeting the following day to ensure end users are prepared for the upcoming change. Changes are typically implemented the following Tuesday after JSaAB approval, with limited exceptions for expedited releases or situations where additional time is needed for review by the Federal Change Control Board or the distribution of related communications.