The Veteran’s Administration (VA) currently has 9 million enrolled patients. The VA electronic medical
record, VistA, and its EHR module known as CPRS, were developed and enhanced largely by clinicians over the last
25 years. Most CDS in VistA has evolved in the 130 local instances of VistA, with no formal mechanism for sharing.
This year, VA signed a contract to adopt a commercial EMR similar to the one being adopted by the Department of
Defense – a maneuver intended to facilitate free flow of information between these two federal organizations which
share patients but no interoperability. This decision presents the VA with the opportunity to work with DoD on
streamlining and optimizing CDS to improve patient and provider experience, while reducing cognitive and
implementation burden. The VA-DOD experience can be viewed as a ‘snapshot’ of the challenges facing the larger
healthcare community in this regard. An essential underpinning of this work is standardization of the representation
of clinical statements, and integration of the terminologies used to populate those clinical statements. This last goal
is a challenge whose success is essential to achieving true interoperability of CDS not only between VA and DOD,
but among all US health care entities.

Learning Objective 1: Recognize the key role that standardizing CDS plays in optimizing patient care and reducing clinician cognitive burden.

Learning Objective 2: Identify successful strategies to standardize the representation of clinical statements and integrating the terminologies we use to populate those clinical statements and their importance to achieving interoperable CDS.


Eleanor Barone (Presenter)
VA -Fayetteville VAMC

Diane Montella (Presenter)
Veterans Health Administration

Linda Wedemeyer (Presenter)
Veterans Health Administration

Keith Campbell (Presenter)
Veterans Health Administration

Presentation Materials: