A description of rapid design and implementation of new features in an electronic health record in the United States Department of Veterans Affairs, Veterans Health Administration response to the Covid-19 pandemic

The onset of the COVID-19 global pandemic called for the implementation of new functionality to the Electronic Health Record (EHR) system for the United States Department of Veterans Affairs (VA), and VA responded rapidly. VA’s EHR-related COVID-19 response can be grouped into two categories: 1) a new banner to provide a rapid way to view a patient’s COVID-19 status and 2) EHR templates for addressing COVID-19 screening and patient care during the COVID-19 pandemic. COVID-19 clinical reminder dialog templates were rapidly implemented to meet provider and patient needs for scenarios involving the care of patients suspected of COVID-19 infection and for treating and monitoring patients who tested positive. Semi-structured interviews were conducted with solution developers and users to elicit feedback on the design process as well as overall usability and utility. The new functionality in the EHR was developed, evaluated, and delivered at record speed in real time as the pandemic unfolded. This paper presents the process used for the rapid delivery of the new functionality and describes how VA was able to maintain a high standard of usability while creating this enhanced functionality in the face of an unprecedented challenge.