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EHR Overlays: Critical Workflow Tools for Frontline Providers
Share PrintBuilt as electronic health record (EHR) overlays, this software enhances baseline systems like VistA/CPRS and Oracle Health, transforming existing platforms into more innovative, clinician‑centered tools. Developed in close collaboration with frontline VA staff, more than 20 custom solutions have been co‑designed to address workflow‑specific needs, delivering intuitive, high‑impact tools tailored to VA care delivery. These tools extend the ecosystem by filling gaps where baseline functionality does not exist or where no enterprise standard has yet been defined.
Origin:
January 2016, Lieutenant Colonel Charles S. Kettles VA Medical Center (Ann Arbor)
Adoptions:
14 successful
Awards and Recognition:
VHA representative for Federal Lab Consortium Excellence Award (2023 and 2025)
Partners:
Academic Affiliations, VA Technology Transfer Program
Recent Updates
Overview
Problem
This innovation tackles a fundamental challenge in healthcare: despite national and enterprise standards that shape how electronic health records (EHRs) are built and shared, gaps still exist in areas that matter to frontline providers, where real-time decisions, collaboration, and patient care intersect. This gap disempowers frontline providers instead of s
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This innovation tackles a fundamental challenge in healthcare: despite national and enterprise standards that shape how electronic health records (EHRs) are built and shared, gaps still exist in areas that matter to frontline providers, where real-time decisions, collaboration, and patient care intersect. This gap disempowers frontline providers instead of supporting them with intuitive, connected solutions. This not only slows care but also fragments communication and limits the potential of real-time data to improve Veteran outcomes.
Our approach strengthens and extends enterprise standards, enriching the ecosystem that supports them by creating tools that make the system more usable, responsive, and aligned with the realities of frontline clinical work. By filling the spaces where national standards don’t yet exist—and reinforcing those that do—this innovation helps clinicians work smarter, deliver safer care, and capture the full value of a modern, interoperable digital health system. See more
Our approach strengthens and extends enterprise standards, enriching the ecosystem that supports them by creating tools that make the system more usable, responsive, and aligned with the realities of frontline clinical work. By filling the spaces where national standards don’t yet exist—and reinforcing those that do—this innovation helps clinicians work smarter, deliver safer care, and capture the full value of a modern, interoperable digital health system. See more
Solution
To address EHR challenges, clinician-centered software that sits on top of baseline systems such as VistA/CPRS was developed to make them more usable, more intelligent, and more responsive to frontline needs. Working side by side with frontline VA staff, more than 20 custom EHR overlay tools have been co-developed and specifically designed to improve care co
...
To address EHR challenges, clinician-centered software that sits on top of baseline systems such as VistA/CPRS was developed to make them more usable, more intelligent, and more responsive to frontline needs. Working side by side with frontline VA staff, more than 20 custom EHR overlay tools have been co-developed and specifically designed to improve care coordination, streamline workflows, and support decision-making in real clinical settings. These tools get real-time data from all VA sites using VistA/CPRS. Examples of these EHR overlay tools include:
- Comprehensive Obesity Tool with Population Health Management: An end-to-end obesity care platform that streamlines telehealth intake, automates documentation, provides clinical decision support, and enables coordinated care among physicians, dietitians, nurses, and pharmacists. A population health layer identifies early non-responders, supports targeted outreach, and improves access by flagging patients who are ready to be transitioned back to primary care. The tool also allows passive monitoring of discharged patients, enabling re-engagement if outcomes worsen. Integrated population health and pharmacy analytics track weight and cost outcomes in real time, ensuring that high-cost medications are achieving intended results.
- Group Notes: A flexible documentation tool that lets providers create a single note and send it to multiple patient charts. Shared intervention text is auto-filled, while patient-specific details are customized for each individual. Currently used by dietitians and pharmacists for MOVE! group classes and by nurses for medication education, the tool significantly reduces documentation time while maintaining individualized care.
- Pharmacy Cost Reduction Tool* (Adaptable, including GLP-1 Agonists): A dynamic pharmacy analytics and workflow platform that identifies high-cost prescribing patterns and supports safe, protocol-driven transitions to lower-cost, higher-value alternatives. It facilitates workflow management, semi-automates chart review, group note generation, and letter creation, and promotes multidisciplinary collaboration with outcomes tracking to drive sustainable cost savings.
- Turbo QI: A configurable quality improvement platform that allows teams to design, track, and execute clinical and operational improvement projects using real-time patient data. It supports both frontline workflows and leadership-level KPI monitoring through integrated workflow management, semi-automated chart review, group note creation, multidisciplinary collaboration, and outcomes tracking.
- Provider and Nursing Sign-Out Tool: A shared, real-time sign-out workspace that aligns providers and nurses around current clinical status, active issues, and care plans—improving handoffs, communication, and patient safety.
- Turbo Patient Lab Letter: A documentation assistant that helps providers quickly review lab results, generate clear explanations, and send consistent, patient-friendly result letters with minimal effort.
- After Visit Summary: An automated and standardized visit summary that communicates diagnoses, medication changes, follow-up plans, and instructions clearly to enhance patient understanding and adherence after the visit.
- Admission Navigator: A guided inpatient admission tool that organizes critical clinical data, streamlines medication reconciliation, and supports efficient creation of accurate, high-quality admission notes.
- Discharge Navigator: A discharge coordination tool that combines documentation, medication reconciliation, and patient instructions to support safe, timely, and consistent discharges from the hospital.
- Inpatient Dashboard (Resident Rounding Tool): A centralized inpatient workspace that consolidates vitals, labs, intake/output, notes, sign-out, and medication reconciliation in one view. It streamlines collaborative rounding and note writing, saving care teams more than 30 minutes per day.
- Medication Reconciliation Tool: An integrated reconciliation tool designed for both inpatient and outpatient settings, ensuring accurate medication review and reducing errors during transitions of care.
- Outpatient Turbo Note: A core outpatient documentation tool that aggregates data from across the EHR into an intelligent template, accelerating chart review and note writing while consistently saving providers over 30 minutes per day and helping reduce burnout.
*For the FY26 VHA All-Employee Innovation Program replication effort, the focus will be on the Pharmacy Cost Reduction Tool and a Medical Weight Management Population Health Dashboard.
The tools are VA-owned intellectual property managed and licensed through the VA Technology Transfer Program (TTP). The original team are inventors of this technology. The tools may result in royalities to the VA which is distributed by the VA Technology Transfer Program in accordance with the VA Royalty Distribution Policy and can lead to royalties to the inventors. See more
- Comprehensive Obesity Tool with Population Health Management: An end-to-end obesity care platform that streamlines telehealth intake, automates documentation, provides clinical decision support, and enables coordinated care among physicians, dietitians, nurses, and pharmacists. A population health layer identifies early non-responders, supports targeted outreach, and improves access by flagging patients who are ready to be transitioned back to primary care. The tool also allows passive monitoring of discharged patients, enabling re-engagement if outcomes worsen. Integrated population health and pharmacy analytics track weight and cost outcomes in real time, ensuring that high-cost medications are achieving intended results.
- Group Notes: A flexible documentation tool that lets providers create a single note and send it to multiple patient charts. Shared intervention text is auto-filled, while patient-specific details are customized for each individual. Currently used by dietitians and pharmacists for MOVE! group classes and by nurses for medication education, the tool significantly reduces documentation time while maintaining individualized care.
- Pharmacy Cost Reduction Tool* (Adaptable, including GLP-1 Agonists): A dynamic pharmacy analytics and workflow platform that identifies high-cost prescribing patterns and supports safe, protocol-driven transitions to lower-cost, higher-value alternatives. It facilitates workflow management, semi-automates chart review, group note generation, and letter creation, and promotes multidisciplinary collaboration with outcomes tracking to drive sustainable cost savings.
- Turbo QI: A configurable quality improvement platform that allows teams to design, track, and execute clinical and operational improvement projects using real-time patient data. It supports both frontline workflows and leadership-level KPI monitoring through integrated workflow management, semi-automated chart review, group note creation, multidisciplinary collaboration, and outcomes tracking.
- Provider and Nursing Sign-Out Tool: A shared, real-time sign-out workspace that aligns providers and nurses around current clinical status, active issues, and care plans—improving handoffs, communication, and patient safety.
- Turbo Patient Lab Letter: A documentation assistant that helps providers quickly review lab results, generate clear explanations, and send consistent, patient-friendly result letters with minimal effort.
- After Visit Summary: An automated and standardized visit summary that communicates diagnoses, medication changes, follow-up plans, and instructions clearly to enhance patient understanding and adherence after the visit.
- Admission Navigator: A guided inpatient admission tool that organizes critical clinical data, streamlines medication reconciliation, and supports efficient creation of accurate, high-quality admission notes.
- Discharge Navigator: A discharge coordination tool that combines documentation, medication reconciliation, and patient instructions to support safe, timely, and consistent discharges from the hospital.
- Inpatient Dashboard (Resident Rounding Tool): A centralized inpatient workspace that consolidates vitals, labs, intake/output, notes, sign-out, and medication reconciliation in one view. It streamlines collaborative rounding and note writing, saving care teams more than 30 minutes per day.
- Medication Reconciliation Tool: An integrated reconciliation tool designed for both inpatient and outpatient settings, ensuring accurate medication review and reducing errors during transitions of care.
- Outpatient Turbo Note: A core outpatient documentation tool that aggregates data from across the EHR into an intelligent template, accelerating chart review and note writing while consistently saving providers over 30 minutes per day and helping reduce burnout.
*For the FY26 VHA All-Employee Innovation Program replication effort, the focus will be on the Pharmacy Cost Reduction Tool and a Medical Weight Management Population Health Dashboard.
The tools are VA-owned intellectual property managed and licensed through the VA Technology Transfer Program (TTP). The original team are inventors of this technology. The tools may result in royalities to the VA which is distributed by the VA Technology Transfer Program in accordance with the VA Royalty Distribution Policy and can lead to royalties to the inventors. See more
Images
EHR Overlay
Links
- Multiple Patents related to the EHR overlay software innovation have been filed by the VA Technology Transfer Program, establishing the tools as VA-owned intellectual property. The original team below are inventors on these patents. This intellectual property is licensed by National VA Tech Transfer Program, enabling broader deployment while preserving VA’s ownership and oversight. paige.zimerman@va.gov
- Publication Comprehensive Obesity Program
Results
These EHR overlay tools have driven substantial improvements in access, efficiency, and outcomes across VA care settings. At the VA Ann Arbor Healthcare System (VAAAHS), for example, the Medical Weight Management Program saw a more than 1,700% increase in new consults—from 74 in FY20 to over 1,359 in FY24. By streamlining tracking, documentation, and populat
...
These EHR overlay tools have driven substantial improvements in access, efficiency, and outcomes across VA care settings. At the VA Ann Arbor Healthcare System (VAAAHS), for example, the Medical Weight Management Program saw a more than 1,700% increase in new consults—from 74 in FY20 to over 1,359 in FY24. By streamlining tracking, documentation, and population health management, these tools have enabled the VAAAHS to scale care and expand access without requiring a proportional increase in staffing.
A Pharmacy-led initiative successfully used a cost-savings tool to transition Veterans from costly GLP-1 agonists to clinically equivalent or better, lower-cost alternatives, putting the VA Ann Arbor Healthcare System on track to save more than $1.2 million annually. The TurboQI tool enables clinical teams to design, track, and execute both clinical and quality improvement workflows using real-time patient data, while an Oncology dosing tool helps manage pembrolizumab immunotherapy spending through precise, weight-based dosing that supports safe, cost-effective care.
Providers consistently describe the tools as highly time-saving and easy to adopt—reflected in their widespread use among 6,000+ VA staff with more than one million documented encounters annually—demonstrating scalability and major impact on care quality, clinical efficiency, and cost-effectiveness across VA. See more
A Pharmacy-led initiative successfully used a cost-savings tool to transition Veterans from costly GLP-1 agonists to clinically equivalent or better, lower-cost alternatives, putting the VA Ann Arbor Healthcare System on track to save more than $1.2 million annually. The TurboQI tool enables clinical teams to design, track, and execute both clinical and quality improvement workflows using real-time patient data, while an Oncology dosing tool helps manage pembrolizumab immunotherapy spending through precise, weight-based dosing that supports safe, cost-effective care.
Providers consistently describe the tools as highly time-saving and easy to adopt—reflected in their widespread use among 6,000+ VA staff with more than one million documented encounters annually—demonstrating scalability and major impact on care quality, clinical efficiency, and cost-effectiveness across VA. See more
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Month 0–1: Site Readiness Assessment
Conduct an assessment of the target VA site’s EHR version, telehealth capacity, pharmacy formulary, top 25 pharmacy drug costs, and available medical weight management options. This step confirms that the site can support the initial replication package, which includes the GLP-1 agonist pharmacy cost-saving tool and a weight management population health dashboard, and identifies local gaps and opportunities. -
Month 1: Clinical and Cost Rationale Alignment
Review GLP-1 utilization, costs, and access at the site to align stakeholders around the case for change. Emphasize that GLP-1 agonists represent a major cost driver, that more than half of Veterans may meet eligibility criteria yet relatively few receive therapy, and that prescribing patterns and data capabilities vary widely, limiting the ability to optimize both outcomes and costs. -
Month 1–2: Technical Deployment
Coordinate with the National VA Technology Transfer Program to ensure secure, compliant access and deployment of VA-owned software tools in alignment with VA intellectual property requirements. Confirm technical connectivity, user permissions, and any necessary local IT configurations to ensure the tools can be safely implemented and reliably used at the new site. -
Month 2: Configuration and Workflow Design Workshop
Host a two-day virtual configuration workshop with local clinical, pharmacy, and operational leaders. During this workshop, teams map existing workflow challenges, adapt pre-built templates, and design efficient, optimized processes for GLP-1 prescribing, cost management, and weight management population health tailored to the site. -
Month 2–6: Go‑Live and Mentored Implementation
Launch the tools at the site with structured go-live support. Provide real-time, “elbow-to-elbow” virtual mentoring for local champions as they use the tools in daily practice, refine workflows, and troubleshoot issues, ensuring smooth adoption and early demonstration of access, efficiency, and cost-savings benefits.
Departments
- Primary care
- Quality Management
- Medical Informatics
- Diabetes
- Bariatric surgery
- Information technology
- Pharmacy
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Misalignment between the project’s demands and local workforce capacity, expertise, leadership priorities, and current pharmacy cost pressures. If time, skills, or priorities do not match the implementation plan, the project may stall or underperform. | Begin with a structured readiness assessment and stakeholder mapping to clarify available staff, local champions, and high-priority drug classes or clinics. Use this information to right-size the scope, phase work around existing initiatives, and clearly link the project to leadership goals (e.g., cost savings, access, outcomes). |
| Insufficient buy-in from pharmacy leadership or the absence of a clearly identified point person who “owns” the implementation and outcomes, including responsibility for driving both cost savings and clinical impact. Without clear sponsorship and accountability, the tools may be technically deployed but not meaningfully integrated into day-to-day practice. | Engage pharmacy and service-line leaders early using concrete data on projected cost savings and clinical benefits, and secure formal designation of a local lead or small core team. Provide that lead with clearly defined responsibilities, regular check-ins, and transparent metrics (e.g., GLP-1 cost per patient, Veterans lost to follow-up among those on GLP-1 therapy) so progress is visible, success is attributable, and leaders remain invested in sustaining the work. |
| Facilities are already navigating significant change with the national EHR transition, which increases the risk of change fatigue, skepticism, or resistance to “one more tool.” If the tools are perceived as complex, duplicative, or unstable, adoption is likely to be low. | Emphasize that the EHR overlay tools are designed to simplify work, not add extra clicks—keeping interfaces intuitive, workflows short, and training minimal. Demonstrate software compatibility with local systems using real frontline scenarios during training, and provide high-touch go‑live support so staff experience immediate time savings and workflow improvements rather than additional burden. |
| Access to real-time Oracle Health data to enable the tools to function with the new Federal Electronic Health Record just as they do with VistA/CPRS. | We are currently working with the National Technology Transfer Program, VISN 10 Leadership Team, and our local Executive Leadership Team to ensure that the tools developed at the VA Ann Arbor Healthcare System Software Innovation Hub can have access to real-time Oracle Health data, as they currently do with VistA data. |
About
Origin story
Dr. Gabriel Solomon began this work more than a decade ago, pioneering mission-aligned innovation within the VA by creating a pathway to develop software tools that use real-time data and clinician insight to address frontline challenges. Over the past five years, this effort has matured through the VA Ann Arbor Healthcare System (VAAAHS) Software Innovation
...
Dr. Gabriel Solomon began this work more than a decade ago, pioneering mission-aligned innovation within the VA by creating a pathway to develop software tools that use real-time data and clinician insight to address frontline challenges. Over the past five years, this effort has matured through the VA Ann Arbor Healthcare System (VAAAHS) Software Innovation Hub, directed by Dr. Devvrat Malhotra with leadership from Dr. Solomon and Dr. William Weitzel. The hub serves as a national model for VA software innovation, developing and deploying advanced, clinician-driven EHR overlay tools that enhance care delivery and operational efficiency. Built through Cooperative Research and Development Agreements (CRADAs) with the VA Technology Transfer Program, and in strategic partnership with universities and industry collaborators, these efforts exemplify the power of scalable, clinician-centered innovation that strengthens the VA’s mission to deliver higher-quality, more efficient care for Veterans.
Original team
Devvrat Malhotra
Director of VAAAHS Software Innovation Hub & Co-Director of Weight Management and Metabolic Health Program
Gabriel Solomon
VAAAHS Associate Chief of Staff for Informatics & VAAAHS Federal EHRM Change Lead
William Weitzel
Physician
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