Innovation and Adversity: The Implementation of a Unified Electronic Health Record for U.S. Veterans
(Stanford Graduate School of Business Case SM-402, May 7, 2025; 24 pages)
Authors: Priti Lakhani, John Beckett, David Brancato, and Kevin A. Schulman
Introduction:In the predawn stillness of a crisp Washington morning, Dr. Priya LaManna confronted a digital deluge that threatened to overwhelm her nascent leadership role. As the newly appointed director of quality, safety, and value for the electronic health record modernization at the U.S. Department of Veterans Affairs (VA), she found herself at the epicenter of a complex organizational transformation that was evaluating the boundaries of technological implementation and institutional change management.
The electronic health record (EHR) “go-live” in Spokane, Washington, had ignited a firestorm of criticism that now populated her inbox with a torrent of increasingly hostile communications. Each email represented not just a complaint, but a potential inflection in a multibillion-dollar modernization initiative that carried profound implications for health care delivery for America’s veterans.
LaManna’s professional trajectory had uniquely positioned her for this pivotal moment. Her career had traversed the complex landscape of health care technology, including a significant tenure at Cerner, where she had led the Patient Safety Council, and a subsequent role as chief medical information officer at a prominent academic medical center. Her dual expertise in patient safety and medical informatics made her an ideal candidate to navigate the turbulent waters of this massive technological integration.
The initial EHR implementation at the VA had faced such a public outcry that Congress had called for a “reset” before progressing. LaManna took a deep breath, took a sip of her mint tea, and considered how to tackle the emails and never-ending calls regarding safety issues, workforce dissatisfaction, and congressional inquiries.
Download the case here. For inquiries, contact Kevin Schulman: kevin.schulman@stanford.edu