Terry Gerton You have a huge responsibility over there at VA. VHA is one of the largest medical systems really in the world. But we wanna talk today specifically about health IT modernization there. So when you think about the entire system and you think of all the IT systems that are part of it, what does better look like? How do you define better?

John Bartrum So, for me, better means delivering the best health care possible to our veterans, because we serve them. And that’s what we’re here to do. We’re here serve veterans. So over the past few decades, veterans, veteran advocacy groups, Congress, the Government Accountability Office, the Office of Inspector General, independent commissions, and our employees have risen a number of flags. And the primarily one was if VHA does not restructure, we’ll fall behind and veterans will pay the price. So the president, Secretary Collins and I do not plan to let that happen. And so we are fixing that and we’re fixing parts of the system that are broken. And VHA’s Restructure for Impact of Sustainable Effort, or RISE, aims to address the challenges that face the VHA healthcare system. And so RISE is focused on enhancing veteran care, improving our quality, safety, continuity of care through seamless coordination between direct care and community care service. Enhancing operational consistency, which is reducing conflicting policy and care delivering guidelines through standard implementation of clinical and business operations across our entire VHA system. Enhanced market level agility, which supporting adapting to emerging health care trends so that our system is at the forefront of all systems and technologies. And focusing, obviously, on care delivery. Redirecting resources to the front line of care. And so we’re doing that in a number of different ways. On redirecting the resources, we’ve got this year, we’re spending roughly $5 billion, $4.8 billion on restructuring and modernizing our facilities. So we have 170 hospitals, and we have about 1,300 sites of care, and so spending $4,8 billion on those. But that allows us to spend about a billion dollars to enable us to roll out the electronic health record. And so recently I was up in Dayton as we rolled out the next wave of electronic health care go-lives. And so Dayton, Cincinnati, and Chillicothe recently went live. We had just prior to that rolled out electronic health records in Michigan and we have sites rolling out here in the near future in Indiana and other parts of the Midwest.

Terry Gerton You just rolled a whole lot of information into that first question, and so I wanna try to pick it apart a little bit and go into more depth with some of those things. You talked about providers and veterans and trying to reduce friction there. Where do you see the biggest friction points in terms of how both providers and veterans engage with BHA through its IT systems?

John Bartrum Well, so there’s an old saying that if you’ve seen one VA, you’ve seen one VA. And we frequently hear this from veterans, from veteran advocacy, oversight committees and also our own providers. And so what we’re working to do is to eliminate those inconsistencies. And part of our reorganization and restructure gets to that. So the current structure that we have is riddled with redundancies that slow decision making, sew confusion and create competing priorities. Under this reorganization of VHA, policymakers will set policy, regional leaders will focus on implementing those policies, and clinical leaders will focus on what they do best, taking care of veterans.

Terry Gerton So that consistency of care is a big theme for you. You also mentioned community care. So how are you balancing inside the systems the kinds of care and the experience of the user across community care and VA site care?

John Bartrum Veterans Healthcare System is the largest integrated healthcare system in our country, as you pointed out. But let’s paint a picture of that. As I mentioned earlier, we operate nearly 1,400 sites of care across the nation. The comprehensive integrated system is 170 VA medical centers. In addition to that, you had mentioned Community Care. We have our Community Care providers, which are contractors that provide care for us and care for our veterans outside the system. So we have VA Direct Care and we have VA Community Care. By the end of 2026, we estimate that there will be approximately 14.3 million veterans who are eligible to enroll in VA health care. As of March, there were 9.2 million veterans enrolled in the VA healthcare system. And we’re working diligently to reach out to the approximately 5 million veterans who are eligible but not currently enrolled. Veterans will choose to enroll in us or not enroll with us if they’re eligible because they might have other health insurance, they might be a retiree, they might have DoD Tricare as a retire. They have that choice to where they want to get care. But when they’re in our system they also have choice depending on what criteria they meet and what the wait times are as to whether they use our Direct Care system or whether they use our Community Care. But with that said, everything we do is about enhancing veteran care. We’re here to serve veterans and we’re listening to their common concerns. With the reorganization, we’ll be better positioned to focus on care delivery, not bureaucracy. The result will be more defined roles and responsibilities for our veterans to understand who does what and how they get things done. So our reorganization was first announced publicly in December. And we set out goals of improving healthcare for veterans, empowering local hospital directors, and eliminating duplicate layers of bureaucracy and ensuring consistency across the system. But it didn’t start in December. We actually began the process in March of 2025. And it wasn’t developed by the politicals who came in with the new administration. This was developed by VHA leaders, our Veterans Health Administration leaders. They started doing visioning sessions, they did sessions with thousands of Veterans employees and Veterans providers across the country to look at how should we have our health care system look into the future. We studied successful models from public and private health care. So we looked at the HCA health care systems. We looked at Kaiser. We looked a Common Spirit, Trinity Health, the Defense Health Agency, DoW generally, and Indian Health Service. In addition, we evaluated three of the most recent VHA failed restructuring attempts to look at what we could learn from those past challenges. We looked at multiple GAO and OIG and congressional reports, but most importantly, we listened to our veterans and our VSOs and our employees. So that’s how we’re getting after better to make sure that we’re taking care of our veterans, and putting that first.

Terry Gerton So let’s follow on from that reorganization description and come back to community care for a minute because one of the other things you’ve been pushing is this whole health approach to care for veterans. And when veterans are receiving care across multiple systems, I’m curious as to what you find as the biggest challenges there. Is it collecting data? Is it sharing data? What makes gathering whole health information on veterans especially challenging?

John Bartrum There are challenges with data systems and how data systems interact and data systems that our healthcare providers in the outside have. So we’re in the process right now of re-competing our community care contract. As part of that community care contact, re-compete, which is in the RFP, will be enhanced ways for that data to be shared back to us so that we get the data faster. In addition to that, there are other efforts going on their way, especially with our rolling out of our electronic health record, which will enhance the ability for us to collect that data as we’ll become more interoperable with the health care system at large. So sharing data, getting data from the community is very important. But when you look at the delivery of care, the majority of our veterans who are eligible for community care choose to also drive and use our care at their local VA facility. Because I think what veterans realize is that our providers in our healthcare system understand veterans in the unique nature of what veterans have gone through and the experience of veterans better than most community care providers. And so while they may go out and do a colonoscopy, for example, at a local provider or maybe get an eye procedure done, they tend to come back more often than not and have a higher reliance on our healthcare systems than they do the private sector. That’s all. Having that coordination and having that information flow back and forth is critical.

Terry Gerton A lot of times that specialty care they’re getting on the community is also related to social and mental health, behavioral health. So as you’re putting together a whole health picture of the veteran, how important is it to make sure that you get all of those pieces back into this new now electronic health record?

John Bartrum No, it’s really important, but I appreciate that question, because most Americans, I don’t think realize the wide range of health care systems and services that we provide for our veterans. Obviously, primary care and mental health care, a lot of people understand and know that we do. PTSD, those are types of things that we work with all the time. And I think we have the best programs in the country on those. But in addition, we do services that other health care systems don’t do, like homelessness. And we have programs where we work with HUD, and we have a HUD-VASH VA, Voucher for Assistant and Supportive Housing program, which will pair permanent housing rental vouchers with the VA to help veterans and their families to find and sustain housing. And those programs come with wraparound services to where we help the veteran with job skills, with mental health, with substance abuse if they need it, or with geriatric care. And so we do a lot of different programs that are tied around that social service for our veterans. And our various services require a lot of coordination, and that’s why we continue to adapt new ideas and innovation. And you mentioned the federal electronic health record. That helps and allows us to seamlessly manage the data exchange between VA, the Department of War, and improve the customer service and connectiveness and convenience for veterans. And so, in the VA right now, we’re working with DOW to try and make sure that we’re getting electronic records from veterans from day zero, from the day that they start their military service. And I think, as you know, Terry, that you’ve been around a while, that’s been long-time effort, but we and our deputy secretary has been focused on that and working with the Department of War on that effort.

Terry Gerton So you raised something really interesting because I was focused on asking about how you’re sharing health information with community care partners and those sorts of things. But when you bring up the social services, the homelessness pieces, those come from inside VA, from VBA. And so are you finding that it is challenging even within the Veterans Administration to share information across those two silos within the department?

John Bartrum No, I think we do a pretty good job of sharing information inside. It’s the matter of getting the information into us so that we have the information. And then as we work on the information on the health care side, it’s sharing the information as we go with our community. And so as we roll out our next community care contracts and as we rule out the electronic health record, I think we will enhance our ability to share our information with our community partners and getting that information back more quickly from our community care partners.

Terry Gerton Let’s dig a little more deeply into the EHR. I don’t necessarily want to visit the history of it. It’s long and perhaps complicated, but let’s talk about where you are right now. What are you doing differently as you roll out EHR now that you think increases its probability of success?

John Bartrum Well, one, electronic health records, when it was first rolling out more than a decade ago, were not as common throughout the system. But nowadays, there’s basically two players out there, the company we’re using and another company. And so when you go around to most of our doctors, think about our VHA doctors. A large percentage of our doctor’s don’t work for us full time. They will work part-time at a local university or a local academic center. And a lot of them will be halftime or three-quarter time providers. And so what that means is they’re already using this system or its competitor’s system. And so EHRMs have become much more mainstay throughout the entire health care system. So I think that that helps tremendously with ensuring that the adoptions and the acceptance rate among staff. But we’re also using super users. And so we’re working with throughout the country with with our users who’ve been on the system for more than a decade to bring that information forward and for training and enhancing the training, and then also making sure that we have standardized workflows. I think the advantage of these EHRs is to standardize the workflow so that it’s consistent across the country. And so I think large scale systems have to have standardized workflow as they roll these out and that increases the likelihood of success.

Terry Gerton The flip side of standardized processes has got to be standardized data. When you think about having EHR maybe in its fully deployed state, you’re going to know a lot more and have access to a lot of information about your veteran clients. How do you think that data will change the practices, the focuses, the content of VA Medical Care.

John Bartrum I think we’re looking forward to getting more of that data, not just from an actuarial standpoint to understand how veterans are using our system, where veterans are moving, the types of care that they’re migrating into and out of, but also from a research standpoint. As you know, Terry, I was associate director at NIH years ago, and we used a lot of big data on research, and that data was able to allow researchers across the country to look at a lot of health service trends. And I think that as we get to a more robust data set with the full rollout of the electronic health record, that I believe that our researchers will be asking, how do we get access to that to mine that data? Obviously, where it doesn’t have identifiable information for our veterans, but just to understand the data and to see what the data tells us as far as where health care trends are moving and how our trends might be different or similar to the health care system in the country at large.

Terry Gerton I know the EHR is the biggest rock in your rucksack, but what other sorts of IT systems or modernization are you looking at or have in process that are going to improve both user experience and the provider experience?

John Bartrum So one of the systems that we have recently adapted throughout the VHA system is what’s called AI Scribe. And so ambient Scribe runs in the background of primary care in a lot of hospital systems and a lot doctors’ offices around the country. And prior to last year, VHA had had license for it, but really had rolled it out well. So what we’ve done over the past year is we refocused on that effort. And we’re rolling that out across the country. And so right now, we’ve wrote out license to all of our primary care providers. Obviously, we need consent from our veterans if they don’t want to have AI Scribe run in the background, we don’t. But if they do, it increases their provider’s ability to, one, more quickly turn around their notes, and two, to have more complete notes of what was discussed in the effort. The provider still has to review the notes. The provider has to sign off on the notes, it just saves them from all the time of typing it, which reduces the burden on the provider but also, I believe, gives our veterans a more accurate view and more robust information than they’ve had in the past. And so we’re looking at how do we roll that out to other parts of VHA. So part of that gets into structured versus nonstructured data and where there are templates, and so we are looking at some of the psychology or some of mental health, some of the internal medicine. Some of the ones that have more of an easier structured type of data system as the next round. In addition to that, we just awarded a pilot for polypharma. And so polypharma is when an individual takes more than five medications at a time. So we’ve done this in the past for years where we would have groups of pharmacists come in and look at records and make sure that we don’t have drug-to-drug interactions. We can’t expect every doctor to know exactly what’s in every single medication all the time, as much as we want to rely on them to do so. So this can look at those drug-to-drug interactions. So we’re doing a pilot, and it’s going to be running in the background, and if this pilot goes as successful as we hope, it will be an opportunity that we can roll it out nationwide across the entire system. So we are looking forward to that. It’s used in the healthcare system, but not in large-scale hospital systems like ours to date.

Terry Gerton One of the biggest challenges that veterans have asserted in the past is scheduling. How are you rolling out new improvements to making an appointment?

John Bartrum Sure, so we’re doing that. As you may know as a veteran yourself, Terry, I don’t know if you use our system, but you may or may not. But if you did, you can schedule certain systems right now on VA.gov for our direct care. And for a number of years, veterans, including myself, have said, why can’t I schedule my community care? And why do I have to have somebody call me and help me schedule it? Because if I’m in Blue Cross/Blue Shield or Aetna or GI or any of the other systems out there and I need a referral. I’m just given a list of phone numbers and saying, you know, go find one. Now we treat our veterans better than that. We actually help them find those and we call out around for them to take that burden off of them. But to some of our veterans, they would rather do it themselves. So we’re working right now on what we call external provider system, EPS. And in EPS, it is going to allow our veterans to go out and self-schedule in the community care and in the direct care system. So we’re working on the pilot right now. We’re testing it out. I can tell you that in the demos that I’ve seen, it’s been very promising. And I won’t say it’s done yet, but I will say that we have commercial partners that we’re partnering with. And if you can, you know, vision with me for a second is that one day, if you’re eligible for community care, for primary care, you’d be able to see your primary care options and your VA. And there’s a reason that I think is really critical as to why this is important. A lot of times VA gets criticized because we have these standards of, you have to have care within 20 days or 28 days, which are not the standard in the healthcare system at large. In most healthcare systems across the country, you have some specialty care you’re not gonna get in 28 days. And so if you can’t get it in 28 day, then you’ll be eligible for community care. And what some of our veterans give feedback to me about is, Well, yeah, but I went there and I couldn’t get care for six months in the community. I had to wait six months. Well, the market is what the market is if that’s how many of those specialists that you have in your community, then you have to wait with what the community has. But I want veterans to know that they might not have been able to get it in 28 days, but they might’ve been able to get in 30 at the VA and/or seven months in the community and now they can pick and what works for them. And that’s what choice is. That’s why, as a veteran of 42 years myself, I can tell you that all of the veterans out there, I have a lot of respect for. They’re my brothers and sisters. That’s who I care about. That’s the reason I’m in this job, is how can we support them? And I believe that this scheduling system and self-scheduling is moving to where they want the ball to go, and we’re working hard to get there quickly.

Terry Gerton You’ve got an awful lot of IT irons in the fire. As you think about trying to balance the effort, the cost, the disruption of all of that deployment, what are you most looking at in terms of your measures of success?

John Bartrum In my measures of success, I look, one, at the clinical aspect of how do we deliver care? What is our quality of care? What is the volume of care that we deliver? But then in my other measures of successful, I looked at how is the reorganization reducing the burden on the system so that we can have more resources to provide to the veterans? So we’re looking across at internal measures and we’re working across at kind of typical hospital measures. As we look forward.