2024 Federal Electronic Health Record Annual Summit Sessions: Frequently Asked Questions

Yes, there is a plan to revisit early DOD sites to update the build to the enterprise standards. For additional information, please email federalehrannualsummit@va.gov.

VA sites going live with the new Federal Electronic Health Record (EHR) in 2026 and beyond should establish a strong change management plan early, ensuring leadership engagement and clear communication with staff. Comprehensive end-user training must be prioritized, including real-world workflows to build confidence before go-live. Dedicated super users—end users with more training in and experience with the Federal EHR—should be identified to provide on-the-ground support, troubleshoot issues, and reinforce best practices. After go-live, continuous feedback loops and performance monitoring will be essential for driving system optimization and ensuring user adoption.

Super users get more detailed training in the Federal Electronic Health Record (EHR) and, over time, gain considerable experience in the Federal EHR. A key characteristic of super users is that they serve as an ongoing resource for their colleagues and remain accessible to address operational questions by providing best-practice guidance on how to use the Federal EHR.

Currently, CPRS and AHLTA DOD legacy clinical data sites are in the Military Health System Information Platform. The front-facing applications are JLV and the Health Information Archive, which are currently being built out. There are no immediate plans set to phase out JLV.

Currently, one to two weeks is the average cycle time. Change requests that are ready for the Federal Electronic Health Record Modernization (FEHRM) office’s Joint Sustainment and Adoption Board (JSaAB) must be ready by the 1 p.m. ET, Monday, deadline. Once approved by JSaAB on Wednesday, a release date is set for the following Tuesday or Thursday (Oracle Health release days). If review by the FEHRM’s Federal Change Control Board (FCCB) is necessary, there will be a two-week lag until the change request is approved by the FCCB.

No, the Department of Defense (DOD) and Department of Veterans Affairs (VA) have separate Global Support Center/ServiceNow ticketing systems. The Jazz tool used to coordinate DOD- and VA-sourced tickets is separate.

Yes, the new system is System Development Life Cycle Next, or SDLC Next, affectionately known as “Bernice.” The system is scheduled for deployment in April 2025.

Yes, the Department of Veterans Affairs has a version of ServiceNow and is actively working on a collateral process that will integrate with the Federal Electronic Health Record Modernization office’s Joint Sustainment and Adoption Board process.

The Department of Defense (DOD) is working on a Disease Management workflow MPage within PowerForms. Generally, during the development of all workflow-related activities, DOD and the Department of Veterans Affairs look to converge whenever possible to achieve enhanced patient outcomes.

That work is continuing. The Federal Ambulatory Working Group has deliberated on several interim ideas for optimizing functionality and improving workflow in the Federal Electronic Health Record. While this is one of them, it is prioritized against other urgent demands.

Yes, the implementation of 3b functionality as part of Capability Block 12 for both the Department of Defense and Department of Veterans Affairs (VA), along with additional functionality already implemented during 2024 (e.g., the date of last fill/refill and a more accurate mediation list in PowerChart as a result of making the Stop Date field optional for both agencies), ensures that the medication list in PowerChart for all users is reflective of all medications that a patient is receiving. Prescriptions that a patient receives by mail order from Express Scripts are the only exception; those items remain only visible in JLV without proper addition of those “home medications” to the patient's medication list via the medication reconciliation process. The implementation of Seamless Exchange functionality within the Federal Electronic Health Record for medications will also dramatically improve the end user’s ability to conduct medication reconciliation with information received from outside partners. Initial implementation is underway at limited VA sites with planned implementation at Defense Health Agency sites as well. Bottom line: Proper medication reconciliation should always be performed for each provider visit.

That functionality currently exists. Within Medication Manager Retail, a history action will allow the end user to review dispense history (also known as refill history). Within PowerChart, the end user now sees the Last Filled date displayed when selecting the patient’s Medication List within the Details tab. The end user can also right-click on the order and select Order Information, then the History tab, and then Dispense History to view complete refill information.

End users can filter out cancelled appointments in the Federal Electronic Health Record by doing the following: Open the appointment book. Under the View or Filter setting, use filter options to exclude cancelled appointments. Select the desired statuses, such as Scheduled or Confirmed, and deselect Cancelled. Once the filters are set, proceed to print the schedule. This should exclude the cancelled appointments from the printout.

In the Federal Electronic Health Record, the Ambulatory Care notes functionality is used by multiple services and departments. Examples include Primary Care and Specialty Clinics, such as Cardiology, Endocrinology, Mental Health, and Pediatrics. These departments, along with other outpatient clinics not listed, use Ambulatory Care notes to document patient encounters, treatment plans, and follow-up care in outpatient settings.

The vendor’s list of safe sites, also known as the whitelist, is hard coded into the system. Periodic updates to the whitelist are ongoing.

Currently, CPT codes are not required by either DOD or VA clinical schedulers.

The surgical history should be based on how the coders finalize the CPT codes.

It depends on whether the tracking board is used in the perioperative vice emergency department setting. In perioperative tracking boards, a New Order column was attempted but not well received.

Due to the excessive number of CPT codes (more than 10,000), the number of preference cards per site is not sustainable; therefore, end users should default to AORN for now.

Yes, the Scheduling Appointment Book is used to schedule procedures and surgeries within the DOD PCL.

The new Federal EHR preference card selection is not based on the specialty of the surgeon and, therefore, is not configurable. The recommendation is to create surgeon-specific preference cards.

Within the Department of Veterans Affairs, Charge Services receive these reports. A Charge Services component for end user use is currently being evaluated. In the meantime, users should meet with Revenue Cycle Management to request any report that could assist in operational performance. The Revenue Cycle and Reporting Team can also assist.

The Department of Veterans Affairs (VA) has a national contract for UpToDate that can be accessed via the VA Library Network. Go to the Veterans Health Administration National Desktop Library website, https://www.va.gov/LIBRARY/index.asp; within the Find a Database drop-down menu, select either UpToDate (off the VA network) or UpToDate (on the VA network). The direct link to UpToDate (off the VA network) is: https://www.wolterskluwer.com/en/solutions/uptodate. The direct link to UpToDate (on the VA network) is: https://www.uptodate.com/contents/search.

To prescribe controlled substances, a provider must have a DEA control number. Providers who cannot obtain a DEA control number should use the institution DEA and National Provider Identifier Number.

Any note creation or other documentation requirements are built into alerts and/or prior authorization medication formulary requirements on both Department of Defense and VA sides. Both Departments leverage system alerts, or Prior Authorization and Medical Necessity requirements, for formulary restrictions and documentation requirements.

The Medication Clinical Display line in PowerChart indicates the refills remaining on an active prescription.

After the implementation of 3b, as part of the release of Capability Block 12, the Department of Defense adopted the current Department of Veterans Affairs functionality, which makes the Stop Date field optional. Prescriptions that reached the Legal Stop Date will still display as active/prescribed in the patient's medication list, and a provider/pharmacist must take an action to discontinue it from the active medication list—which is often completed by renewing the medication order, since the order that reached the Legal Stop Date is no longer actionable. The resulting medication list is more accurate, and the user does not need to adjust filters to see discontinued orders for these cases. Future impact of Seamless Exchange functionality as it applies to patients’ medication lists will also change how end users will be able to view expired medications, but continued use of filters to display discontinued orders is currently still a recommended practice.

Current clinical pharmacy roles—for both the Department of Defense and Department of Veterans Affairs—allow for PowerChart prescribing, similar to provider roles. Any additional certifications achieved by pharmacy staff through state certification still require obtaining credentials through the specific facility that employs that professional. Role assignment in the Federal Electronic Health Record is determined by the credentials assigned by the facility's Professional Affairs staff, within the confines of roles available for the Department. People can always request new roles via the Governance, Risk, and Compliance/ServiceNow ticketing process as well.

Anything beyond consecutive digits in the Quantity field is typically interpreted as free text, which results in the action no longer being codified during translation. This results in See Instructions with interoperable connection to PowerChart from the Medication Manager Retail (MMR) module, or subsequent renewal in MMR. A recent improvement, made after the implementation of Capability Block 12, addresses this question though. If the end user utilizes the standard codified sigs that include “Take 1 to 2 tablets” (i.e., short sig of “t1–2”), the Quantity Per Dose field is codified in MMR as 2 tablets, which also translates into the proper calculation of Days Supply. Educating end users in all aspects of 3b of Capability Block 12, including the new codified dosing fields, was part of Capability Block 12’s 3b implementation.

Proper insurance collection is a standard step in creating an encounter for services. The Federal EHR bases its processing on entering the proper insurance to achieve a billing claim. The absence of this data can result in costs to the Veteran. Procedures and protocols should be available to assist in identifying dental benefits for Veterans. If none exist, please contact Training and Development to assist. To continue the improvement of the Federal EHR, end users should identity gaps in the current approved workflow and recommend improvements or changes for consideration to their local informatics team.

Please reach out to local executive stakeholders for assistance. Being in the role of a PAD and Peer Expert should hold a level of consideration for a ticket to be reviewed.

Work with an immediate supervisor to contact the Informatics Office for additional information on the sunsetting of the Schapptbook software.

It is unusual for a late change to trigger a charge in the Revenue Cycle application. The first recommendation is that an informaticist with medical record configuration expertise review the back-end coding to understand the justification of the late change. Health Information Management always codes after services are rendered; this issue could grow into a problem for patient accounting. Additionally, request that the local manager receive a weekly status report on the progress of the configuration change.

A daily audit report to capture this system error would be beneficial prior to it surfacing within the general ledger. This could be caused by either a system glitch or an end-user error. A daily report should help to quickly identify errors due to the selection of the wrong medical service. Please submit a ticket for this issue.

Templates are applied to resources. A schedule block can be applied over a resource schedule. This has value in that a schedule block could be removed, and an active template would be available to use for booking.

A walk-in is an appointment with an active encounter in real time. The appointment is booked, and the patient is checked in with an active encounter. Booking an appointment into white space is booking an appointment where there is no slot.

Please submit or provide a ServiceNow ticket identifying the defective report name.

This report can be generated, but it requires a formal request via the Reports Generation Process.

Yes, improvements to productivity reports within LON are being completed on a rolling basis, with changes to reports being published through each Department’s weekly end-user engagement presentation. Exactly when each LON report will be improved is in the hands of the Oracle Health Team and/or Centers for Medicare & Medicaid Services Team assigned to the process. Currently, there are more than 800 Global Support Center/ServiceNow tickets pending related to improving reports. Pharmacy productivity reporting concerns are high on the list of improvements for both the Department of Defense and Department of Veterans Affairs; therefore, expect more in 2025.

No, until those sites go live with the new Federal EHR, they will not have access to PowerTrials.