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How the DOD Program Leader is Transforming Military Health

Image of Up-close image of a woman. Holly Joers serves as the program executive officer for Defense Health care Management Systems. (Photo: Josh Brick, Program Executive Office, DHMS)

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Editor's note: This interview was edited for clarity and brevity.

Holly Joers is the sort of champion you want on your side. The program executive officer for Defense Healthcare Management Systems brims with excitement when speaking about what the future of health care will look like for veterans and service members.

“I don’t think we’ve even scratched the surface of what we can do with a single system going forward and the benefits it will bring,” Joers said.

Since joining the federal health space in 2019, Joers has worked hard to lay the building blocks of the future, serving as the interim deputy director of the Federal Electronic Health Record Modernization office, where she helped establish the office’s organizational structure and priorities.

Now serving as the Department of Defense lead in the effort to implement a comprehensive federal electronic health record, Joers sees her tenure at the FEHRM as essential to understanding how the Department of Veterans Affairs and the Department of Defense can work together to transition to a single EHR.

As of June 2022, Joers and her team have transitioned 74 of 138 military hospitals and clinic commands to the new EHR with approximately 114,000 health care providers nationwide. DOD’s deployment effort is at its peak, and the team plans to complete deployment to all military hospitals and clinics by the end of calendar year 2023.

Joers explained how her team deployed the new EHR simultaneously at multiple sites and described what she sees as the future of health care.

Q: How has your experience as interim deputy director for the FEHRM helped you transition to DOD?

A: When I was standing up the FEHRM in late 2019 to early 2020, not only did I gain knowledge about the federal EHR landscape, but I also learned so much about the VA mission and how it is complementary to the military health mission. Over time, I developed a close working relationship with VA leadership and an understanding of how VA’s processes are similar to ours, learning what’s needed to work effectively together. That foundational understanding shaped my mindset that this isn’t just about deploying a system − this is about how we effectively operate the system and its applications to build care for patients.

Q: How do you collaborate with your VA partners?

A: Our team thinks about how we collaborate from the lowest working level up to the leadership level when making day-to-day management decisions. With every decision we [DOD] make, we understand that it is not a sole decision. We constantly think about what the impact is for others using the system and vice versa. For example, at the executive level, there are recurring touchpoints on a regular basis and ad hoc phone calls. At times, Bill Tinston, the director of the FEHRM, will call me to say, "Hey, we have a common challenge or opportunity we want to talk about," and we’ll get on the phone about it. The entire spectrum of operations is taken into consideration.

Q: What was your experience like during your first EHR deployment?

A: For the first wave [the process of deploying the EHR at multiple sites simultaneously], called Wave TRAVIS, we assembled four military and hospital clinic commands and their supporting clinics. We looked at their workflows and made sure people understood how one role affects the next person down the line. We also improved our training and focused on mitigating known risks, which greatly freed up resources to deal with any unknown risks that arose. A notable experience from our initial EHR deployment was the contribution from one of the commanders of that military hospital [DOD’s equivalent of a VA medical center director], Air Force Col. Kristen Beals. I observed how her great leadership − guiding her team through this complex transformation − made it very apparent that the secret sauce to a successful deployment is the leadership on the ground. So, we developed a commander’s workshop that starts 15 months before go-live. There, we gather the entire cohort of a deployment wave to talk about expectations, the critical roles that they need to staff and how important it is to have the right people in those critical roles. We also talk about their anxieties and concerns, and most importantly, we bring in peers who just went through the go-live process and can speak frankly about their experience. The peer experts also provide at-the-elbow training and assistance to new users during the critical go-live period which helps new users build confidence faster.

Q: How was DOD able to transition more complex sites to the EHR?

A: It’s not necessarily one-size-fits-all. For example, when we transitioned Brooke Army Medical Center in San Antonio, Texas, to the new EHR at the end of January, we brought on a Level 1 trauma center, a major hematology-oncology center, a burn center and a unique aspect called [the] Secretarial Designee Program, which provides trauma care to residents of the city of San Antonio and 22 counties in southwest Texas, creating a new dynamic. It’s cliché, but with this new EHR it’s one bite at a time. It is about having the right enterprise approach to say, “How do we use these workflows appropriately?” We talked to other users of the EHR that have complex workflows. For example, we brought in providers from the Jackson Health System in Miami, Florida, to talk about best practices managing complex trauma workflows using the EHR. Those discussions helped us configure new enterprise-wise workflows to standardize the new EHR. Deploying a new EHR is not about trying to match processes and workflows used today, it is about taking this opportunity to standardize, innovate, and optimize how you use the new IT solution to improve outcomes.

Q: On the VA side, we say this is a 10-year program. What do you see as the future of health care with this modernized EHR for DOD and VA?

A: I get really excited about the future. My mantra is, “forward motion.” Let’s keep moving and get the foundational enterprise workflows and standards set so we can innovate and optimize. When our service members transfer from one military base to the next, they should experience the same health care delivery processes. A centralized system brings computable data available in real time. How do we use that data? Joint registries are an area we can grow. While the VA and the DOD call the joint registries different names, they are in the same system, and we want to harness the power of our interconnectedness. I can imagine that, at the end of the day, when someone leaves active duty and they arrive for the first time at a VA facility, their benefits are automatically calculated based on their longitudinal record. No more repeating exams and tests; hard copy service records could be a thing of the past. Working together, the DOD and the VA are on the precipice of making the transition to veteran status so much easier in the future for our soldiers, removing burdens during a time that is already extremely stressful.

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