In 2018, the VA began the monumental process of implementing a new electronic health record (EHR) through Cerner Corporation (purchased by Oracle in June 2022). This vendor was chosen due to the program’s ability to create a single joint patient record between VA and the Department of Defense, creating a continuous health record for seamless transition of care from military service into the VHA. This new EMR will also provide unification and standardization across the VHA, providing support to Veterans during transitions in care.

Five years into this implementation, two of the five active Cerner VA sites currently provide oncology services. The process of learning a new EHR has been a challenge for all parties involved and concerns regarding moving forward have been expressed by many in the VA that will be affected in the future.

To assist with the safe and accurate provision of oncology care to our Veterans in this time of change and uncertainty, the need to involve VA Oncology subject matter experts (SMEs) from different disciplines was identified by the Electronic Health Record Modernization Integration Office (EHRM IO). Current participation includes VA Oncology nurses, pharmacists and physicians from 15 different VA sites as well as National Teleoncology (NTO), with additional onboarding from 6 additional VA sites pending representing a broad expert base. The following workgroups are currently active within the VA and comprised of SMEs, EHRM IO solution experts and Oracle staff members (in some instances) to identify current issues and propose modifications and solutions to existing challenges:

•   VA Oncology Workgroup: established in 2018 when National Councils were formed. The purpose is to discuss any local or national build issues encountered while performing reviews or performing patient care activities in the live domain and providing recommendations for improvement to be presented to the Federal Oncology Workgroup (FOWG).
•   Oncology PowerPlan Sustainment Team: performs detailed clinical reviews of current active PowerPlans and recommend modifications to promote standardization based on clinical evidence.
•   VA EHR Supplemental Training Workgroup: purpose is to identify changes to current oncology processes and workflows at VA Sites that will occur with implementation of Oracle, develop training materials and formulate a plan for deployment of training to be used in conjunction with formal mandatory training.

  Since Oracle has been in use by the Defense Health Agency (DHA) since 2017, the need for collaboration of both VHA and DHA is also an important part of implementation to identify differences in how the system is used as well as identify opportunities for standardization across agencies. Currently, there are VA Oncology SMEs participating in the following Joint Agency Workgroups:

• Federal Oncology Workgroup (FOWG): A legally charter appointed workgroup under Federal Electronic Health Modernization (FEHRM). The purpose of this group is the governance, sustainment, maintenance and optimization of the Oncology Solution.
• Infusion Sprint Workgroup: Subgroup under the FOWG. This group’s purpose is the standardization of non-chemotherapy plans and review requests (IV and injectable plans reviewed).
• MHS Genesis Oncology Regimen Development Team: extension of the VHA Oncology PowerPlan Sustainment Team. Purpose is to jointly review Oncology PowerPlans in Genesis (Oracle product used by DHA) for clinical accuracy, consolidation and depreciation.

  As VHA moves forward with Oracle implementation, utilizing oncology SMEs (nurses, pharmacists and physicians) in both VA and Joint Agency workgroups is a necessity. Future efforts should focus on providing these individuals with dedicated time to participate in activities that will benefit all parties involved.