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Building a modern, EHR-agnostic Lung Cancer Screening tool for VA

Software development

We’re helping modernize the VA’s Lung Cancer Screening application, delivering a clinical decision support tool that integrates with various electronic health record (EHR) systems at VA. This effort enables VA coordinators to accurately track patients, document workflows, and perform clinical operations consistently across platforms.

Client

U.S. Department of Veterans Affairs

The challenge

Lung cancer is the leading cause of cancer-related death among Veterans. The VA’s legacy screening application operated exclusively within CPRS and VistA, VA’s longstanding EHR systems, with fragmented workflows and limited documentation capabilities. This led to significant gaps, like:

  • No ability to write clinical notes back to the EHR or track patients centrally
  • Inconsistent clinical guidance and documentation practices across VA facilities
  • No support for Cerner, the modern EHR system replacing CPRS and VistA, as VA’s modernization accelerated

Our approach

Backend services and interoperability

  • Built core backend services enabling coordinators to create structured notes, health factors, and radiology orders with write-back functionality to both CPRS and Cerner
  • Established API-first development practices with clear endpoint contracts and error-handling standards
  • Engineered a modular service architecture to ensure consistent behavior across EHR systems

Frontend development and accessibility

  • Built React-based interfaces using USWDS components, migrating from Material UI to meet Section 508 and WCAG 2.1 AA standards
  • Integrated automated accessibility checks into the CI/CD pipeline using Pa11y, supplemented by manual audits
  • Ensured screen reader compatibility, keyboard navigation, and mobile responsiveness throughout development

Performance and reporting

  • Optimized a critical reporting query, reducing execution time from 12 seconds to under one second
  • Developed six administrative reports giving coordinators visibility into screening program performance and regional trends

Keys to success

Blue Tiger is a key partner in ensuring the success of this ongoing effort led by Coforma.

  • Modular architecture supporting consistent workflows across two EHR systems
  • API-first development reducing integration friction
  • Accessibility built into the development process
  • Close collaboration with clinical stakeholders throughout

Results and impact

We are helping deliver a production-ready clinical tool that supports the VA’s strategy to reduce lung cancer mortality among Veterans.

  • Deployed an EHR-agnostic application supporting both CPRS and Cerner, ensuring continuity of care during VA’s health record modernization
  • Enabled structured clinical documentation with write-back functionality, improving consistency across VA facilities
  • Reduced critical query execution time by more than 95%, significantly improving application responsiveness
  • Equipped program administrators with dedicated reporting tools to support regional planning and strategic oversight