For John Bartrum, the Department of Veterans Affairs’ under secretary for health, “better” technology at the Veterans Health Administration boils down to one thing: delivering the best possible care to veterans, including through modernization.

“We’re here to serve veterans,” Bartrum said. “How do we deliver care? What is our quality of care? What is the volume of care that we deliver? How can reorganization reduce the burden on the system so that we can have more resources to provide to the veterans?”

The answers to those questions are critical success metrics for Bartrum, direct reflections and outcomes resulting from sweeping efforts under way at VHA to address a range of issues. The challenges at hand span decades-old, familiar-sounding hurdles to obstacles that are emerging as a new generation of service members become eligible for VA health care.

For years, veterans, advocacy groups, Congress, the Government Accountability Office and VHA’s own employees have warned that without structural change, the system would fall behind to the point of devastating consequences for veterans. Bartrum said he and VA Secretary Doug Collins don’t intend to let that happen.

A restructuring built around care delivery

That urgency underpins VHA’s Restructure for Impact of Sustainable Effort, or RISE, an effort Bartrum said aims to enhance veteran care quality and safety, improve coordination between direct and community care, reduce conflicting policies across the system and redirect resources to the front lines of care.

This year, VHA is spending $4.8 billion restructuring and modernizing its roughly 170 hospitals and 1,300 sites of care. That funding also will route approximately $1 billion toward rolling out a new electronic health record system. Bartrum pointed to recent EHR go-lives in Dayton, Cincinnati and Chillicothe, Ohio, which followed earlier rollouts in Michigan. More rollouts are coming soon to Indiana and other Midwest sites, he said.

The reorganization was publicly announced in December, but it’s rooted in sessions that began in March 2025 with thousands of veterans, employees and veterans providers across the country to understand and create a vision for the future of VA health care.

Bartrum emphasized that RISE has been shaped by VHA leadership rather than political appointees. Agency officials have been studying and integrating lessons learned from successful public and private health care models — and from reviewing VHA’s own past failed restructuring attempts and years of findings from GAO, inspectors general and congressional reports.

“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,” Bartrum said. “That’s how we’re getting after ‘better’ to make sure that we’re taking care of our veterans.”

Untangling inconsistency between veterans, providers and the system

“If you’ve seen one VA, you’ve seen one VA” is a refrain Bartrum references to underscore points of friction veterans and providers experience, including in navigating VHA’s IT systems. He’s targeting that challenge accordingly.

“The current structure that we have is riddled with redundancies that slow decision-making, sow confusion and create competing priorities,” he said.

Under the reorganization, policymakers will set policy, regional leaders will implement it and clinical leaders will focus on patient care — a defined chain of command and division of responsibilities intended to give veterans more clarity on who does what.

Data sharing presents its own friction point, particularly as VHA balances direct care with community care delivered by outside contractors. Bartrum said as VHA prepared to recompete its community care contract, officials built the request for proposals specifically to accelerate how quickly outside data flows back into VA systems. The forthcoming EHR rollout is expected to further improve interoperability with the broader health care system.

Even so, Bartrum said most veterans eligible for community care still gravitate back to VA facilities for ongoing treatment, trusting VA providers’ familiarity with veterans’ unique health histories.

That same coordination challenge extends to whole-health needs beyond clinical care, such as homelessness services, job skills support, substance abuse treatment and geriatric care, which also require close coordination, including with the Defense Department. It’s the only way to build a comprehensive picture of each veteran starting from their first day of military service, he noted.

Standardization, AI tools and the road ahead

But what’s different this time around in the EHR rollout? Bartrum cited broader industry-wide adoption of electronic health record platforms — many VHA physicians already use similar systems in part-time academic roles — along with VHA’s work with “super users” with a decade of system experience to support training. Moreover, widespread employment of standardized workflows across facilities further supports successful EHR scalability, he said.

Beyond the EHR, Bartrum highlighted VHA’s expanded use of AI Scribe, an ambient documentation technology now licensed to all VHA primary care providers with veteran consent, which he said speeds up clinical note-taking and improves note accuracy without removing physician review and sign-off. VHA is also piloting an AI tool to flag dangerous drug interactions for veterans on five or more medications, a practice known as polypharmacy management.

On veterans’ long-standing scheduling frustrations, Bartrum said VHA is piloting an external provider system, EPS, that would let veterans self-schedule both direct and community care appointments — a capability he said is already showing promise in demos, with commercial partners involved in development.

As VHA balances cost, disruption and rollout pace across its modernization portfolio, Bartrum said he’s tracking success on two fronts: clinical measures, including quality and volume of care delivered, and organizational measures tracking whether the reorganization is adequately reducing administrative burden.

“How can we support them?” Bartrum said, reflecting on his own 42 years as a veteran. “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.”

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