AI’s promise amid federal EHR growing pains
Gettyimages.com/ Virojt Changyencham
As VA struggle with costs and DOD completes its rollout, artificial intelligence offers a path forward for electronic health records.
While electronic health records systems have seen significant advancements, particularly in the federal government, they also have faced notable challenges in execution.
Two main federal EHR programs – one from the Veterans Administration and the other from the Department of Defense – are at opposite sides of the spectrum in terms of implementation. Both, however, are looking at ways to include artificial intelligence in their offerings to patients and medical professionals.
As early as 2018, the importance of AI for advancement in EHR was detailed in a commentary in the Harvard Business Review. Six years later, the healthcare AI market has been estimated to grow from $20.9 billion in 2024 to $148.4 billion by 2029, with a 48.1% CAGR of 36.4%.
AI holds the promise of making existing EHR systems more flexible and intelligent. Some delivery networks are already using AI to assist with data extraction from free text, clinical documentation and data entry. The technology could help doctors tailor EHRs to their specific needs and work styles, making these records easier to use and more valuable in the care process.
To understand where AI stands in EHR in federal implementations, it’s important first to chart the progress of the healthcare record systems in the VA and the DOD. The two tell different but related stories.
VA sees EHR cost overruns
The VA has been working on its Oracle Cerner EHR system for years, aiming to streamline healthcare for veterans across the United States. The rollout has faced multiple roadblocks, leading to a pause in the implementation in 2024. As of December 2024, the VA was making plans to restart implementation in 2026.
Despite the EHR pause, in December 2024 the VA also issued a recap of its progress to date in creating its “AI Use Case Inventory.” The inventory was created in response to Office of Management and Budget Memorandum M-24-10 in March 2024, requesting these documents from federal agencies.
The VA 2024 AI Use Case Inventory is a collection of over 200 AI initiatives showcases demonstrating how the Department is using to improve the lives of Veterans and empower VA staff.
While the VA paints a rosy picture of the role AI plays in its programs overall, the forecast for its HER modernization program news is somewhat more gloomy, largely due to financial issues.
The current program is budgeted at $16 billion, but true costs may balloon to more than three times that number. That figure was laid out in September 2022 at a hearing before the Senate Subcommittee on Military Construction and Veterans Affairs, by Brian Q. Rieksts, an analyst with the Institute for Defense Analyses.
According to a report from the VA’s Office of Inspector General, Rieksts testified that the program’s cost could rise to $49.8 billion. This includes $32.7 billion during implementation and $17.1 billion for sustainment over 15 years of operation after the system is fully deployed.
In March 2024, the VA announced that it has officially deployed its electronic health record system at the Captain James A. Lovell Federal Health Care Center near Chicago. The center is the only healthcare facility serving both DoD and VA patients. The VA has paused future deployments.
DOD EHR sees final phase of deployment
In contrast, the DOD's MHS GENESIS system has made significant progress. This unified EHR platform serves military service members, veterans, and their families.
MHS GENESIS completed its final site deployment at the same Lovell FHCC where VA announced its most recent (and for the time being, last) EHR implementation.
Lovell FHCC opened MHS GENESIS to providers and patients on March 9, 2024, marking the end of the DOD’s seven-year deployment.
“The launch of the federal EHR at Lovell FHCC will help the DOD and the VA deliver on the promise made to those who serve our country to provide seamless care from their first day of active service to the transition to veteran status,” said Dr. Lester Martínez-López, assistant secretary of defense for health affairs.
In related news, in May 2024, the Defense Health Agency launched a suite of new digital health care tools at five military hospitals, called “My Military Health.” According to the agency, My Military Health is intended to be accessible 24/7 by computer and mobile devices, allowing patients to schedule appointments, engage with automated clinical support for medical conditions, and use self-help wellness programs.
The Defense Health Program, addressing the FY 2025 budget for operations and maintenance, includes a $58.8 million increase to address critical gaps in MHS GENESIS product support: enterprise sustainment, health informatics training, and hardware refresh.
EHR challenges and the role for AI
The implementation of EHR systems faces several challenges, including IT system integration, training for healthcare providers, and concerns about patient privacy. These issues highlight the complexity of transitioning to a fully digital healthcare system.
AI has the potential to address many of these challenges and enhance the functionality of EHR systems. For example, AI can use natural language processing to analyze large, disparate EHR data and produce a clinical summary for the clinician to review before seeing a new patient, alleviating the administrative burden that contributes to clinician burnout. Other ways AI can contribute to improving EHR across the federal government include:
- Automation of Tasks: AI can automate routine tasks, increasing efficiency and reducing the workload on healthcare providers.
- Health Trend Identification: AI can analyze vast amounts of data to identify health trends, aiding in early diagnosis and treatment.
- Resource Management: AI can optimize resource allocation, ensuring that healthcare facilities operate more effectively.
- Cyber Threat Detection: AI can detect and mitigate cyber threats related to patient data security.
- Decision Support: AI can provide healthcare providers with recommendations on diagnoses and treatment options, improving patient outcomes.
- Interoperability: AI can enhance the interoperability of EHR systems, allowing data to be shared seamlessly across different healthcare providers.
The integration of AI into EHR systems represents a promising avenue for improving healthcare delivery and patient outcomes. As federal agencies continue to navigate the complexities of EHR implementation, AI will be a powerful tool to overcoming existing challenges and unlocking new possibilities in healthcare.
Meg Lehman is a healthcare subject matter expert for the healthcare vertical for TD SYNNEX Public Sector, bringing experience from her previous role in operations at a large multi-state health system. Her primary focus is on driving revenue growth and achieving operational excellence through innovative projects that enhanced the patient experience and streamlined workflows. She collaborates closely with clinicians, executive leadership, and IT teams to develop effective solutions for operational challenges and to meet key performance indicators.