VA clinicians help improve the Military Environmental Exposure Assessment

Many of the improvements made to VA’s Federal Electronic Health Record (EHR) have come from the technical experts who observe and optimize the system’s workflows. However, some of the most impactful changes have originated with front-line clinicians—those who use the system daily while caring for patients.

One example is the revamping of the Military Environmental Exposure Assessment (MEEA) PowerForm with an enhancement that improves efficiency by allowing the tool to capture all necessary health information, including critical data from a Veteran’s military history. 

Enterprise-wide change driven from the field

Physician Assistant Megan Baird and Nurse Practitioner Alyssa Musser, members of the Veterans Exposure Team – Health Outcomes Military Exposures (VET-HOME) program, found that documenting Veteran MEEAs in the Federal EHR took significantly longer than in VA’s legacy system, VistA/CPRS, because key clinical information was not auto-populating within the PowerForm. To compensate, clinicians often resorted to copying and pasting information from multiple sources—a time-consuming process that introduced risk inherent in manually transferring data between sources, such as potentially missing essential medical information. Recognizing both the inefficiency and the potential for clinical error, Baird and Musser sought help to solve this issue.

The solution came via a collaborative effort by three different teams: VET-HOME, the Office of Clinical Informatics and Human Systems Integration, and VA’s Electronic Health Record Modernization Integration Office’s Ambulatory Care Solution Management team. They rebuilt the MEEA PowerForm template to include all relevant clinical fields in a single location. The redesigned PowerForm streamlines end-user interaction and ensures that all relevant clinical data is consolidated in one note.  

The team also added a military history section to the provider view, allowing documenting of a Veteran’s military service and deployment history in the Federal EHR. Convenient access to this information allows VA care teams to provide high-quality care for Veterans exposed to environmental hazards associated with deployments, garrisons or military occupational duties. This new military history component is unique to the Federal EHR and not available in VistA/CPRS.

The MEEA PowerForm redesign reduced the documentation time, eliminated the risks of manually transferring patient data between sources and standardized the depth of patient information and its location within the health record.

Fueling data-driven research

The new PowerForm had another unexpected benefit: It enabled the aggregation and de-identification of clinical data for research purposes. This structured data supports studies on military environmental exposures and related health conditions, advancing evidence-based care for Veterans.

Rapid development through collaboration

Through close collaboration, the teams designed, iterated on and delivered the new MEEA PowerForm in just eight weeks.

Feedback from the field has been overwhelmingly positive. Clinicians report faster documentation times compared to the legacy system and improved thoroughness of captured information, contributing to better patient care.

According to Dr. Donna Coffman, a physician with VET-HOME, “The new template is a dramatic improvement over the prior [Federal EHR] note template in that all the information you need is automatically embedded… I love the new feature to add the military dates… I had assumed it would be hard to improve on [the VistA/CPRS template], but this version is even easier to use because I don’t have to go hunting for information on old test results, and I don’t have to redo things that have been thoroughly reviewed in the recent past, such as family history.”

Dr. Edward Post, co-chair of the VHA Ambulatory Tier 1 SME Team, feels this kind of feedback is exactly why his team is guided by end-user engagement.

“This effort is a great example of meeting both the challenge and the opportunity for standardization that EHRM represents for VA,” he said. “Our partners in VET-HOME brought their vision of ‘what’ was needed (a more efficient way of getting their clinical work done) and collaborated with the project solution team who brought the ‘how’ of the Federal EHR system.”

For more information and resources, visit the EHRM website.