Following is a profile of Kevin Meldrum, one of the 2013 EHR Game Changers who were recognized in the annual program sponsored by Health Data Management. For information about this year's recognition program, click here.

For Kevin Meldrum, the career wake-up call was the pounding on the door. The VA-a nationwide group of 152 hospitals serving veterans-had launched an early iteration of computerized physician order entry, and the keyboard-driven system flopped. "We wanted physicians to use the orders," he recalls. The door pounding came from a group of residents who demanded to know if he were the one responsible for the program. "They wanted to know who wrote the software that they didn't want to use. It was a profound experience."

That was in the early '90s. Ever since then, Meldrum has led the charge to try to make the VA's EHR system more user-friendly. The EHR is commonly known as VistA (for Veterans Health Information Systems Technology and Architecture). It now has 150,000 clinical and administrative users across the VA. And beyond that, the system-available for free in the public domain-has been adopted by many international hospitals.

Meldrum has been a steady presence in the EHR's long history. He led the design and development of "CPRS," the computerized patient record system. That's the VA's shorthand for the clinical portion of its VistA system, which Meldrum describes as the underlying architecture and original platform for lab and pharmacy data. Under Meldrum's leadership, the EHR has grown into a Windows-based application that is far easier to use than its keyboard-driven ancestor.

Meldrum developed the first prototypes of the Windows-based system beginning in 1993. By 1996, the system encompassed progress notes and was on its way. That year, Meldrum led the charge to rewrite the software of a 32-bit Windows environment. From 1997-2000, the VA undertook what he calls "rapid revisions," incorporating system changes based on recommendations from some 50 hospital beta sites. During this period, Meldrum's team released 48 updates of the graphical user interface.

Meldrum describes I.T. as a type of living organism that affects the environment around it. And the key to a successful program is being able to intuit what users really need and how they work. "A computer system is like a stimulus to the organization," he says. "The organization will either adapt to it or the system will die."

The VA is not done with the EHR design however. Next up says Meldrum is an upgrade which will enable better care coordination among teams of caregivers by clearly presenting care plans; offer patients better communications tools with their physicians, such as enabling data collection via mobile devices; and enhanced data analytics capabilities. "Working at the VA is amazing," Meldrum says. "There's a sense of camaraderie that is facilitated by the common mission of serving vets."


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