Impacts of an Electronic Health Record Transition on Veterans Health Administration Health Professions Trainee Experience.

Humans Electronic Health Records Veterans Health Learning Health Occupations Surveys and Questionnaires
EHR transitions HPT VHA. mixed methods residents students supervisors user experience

Journal

Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834

Informations de publication

Date de publication:
10 2023
Historique:
received: 01 12 2022
accepted: 13 06 2023
medline: 27 10 2023
pubmed: 6 10 2023
entrez: 5 10 2023
Statut: ppublish

Résumé

Adoption of electronic health care records (EHRs) has proliferated since 2000. While EHR transitions are widely understood to be disruptive, little attention has been paid to their effect on health professions trainees' (HPTs) ability to learn and conduct work. Veterans Health Administration's (VA) massive transition from its homegrown EHR (CPRS/Vista) to the commercial Oracle Cerner presents an unparalleled-in-scope opportunity to gain insight on trainee work functions and their ability to obtain requisite experience during transitions. To identify how an organizational EHR transition affected HPT work and learning at the third VA go-live site. A formative mixed-method evaluation of HPT experiences with VHA's EHR transition including interviews with HPTs and supervisors at Chalmers P. Wylie VA Outpatient Clinic in Columbus, OH, before (~60 min), during (15-30 min), and after (~60 min) go-live (December 2021-July 2022). We also conducted pre- (March 2022-April 2022) and post-go live (May 2022-June 2022) HPT and employee surveys. We conducted 24 interviews with HPTs (n=4), site leaders (n=2), and academic affiliates (n=2) using snowball sampling. We recruited HPTs in pre- (n=13) and post-go-live (n=10) surveys and employees in pre- (n=408) and post-go-live (n=458) surveys. We conducted interviews using a semi-structured guide and grounded prompts. We coded interviews and survey free text data using a priori and emergent codes, subsequently conducting thematic analysis. We conducted descriptive statistical analysis of survey responses and merged interview and survey data streams. Our preliminary findings indicate that the EHR transition comprehensively affected HPT experiences, disrupting processes from onboarding and training to clinical care contributions and training-to-career retention. Understanding HPTs' challenges during EHR transitions is critical to effective training. Mitigating the identified barriers to HPT training and providing patient care may lessen their dissatisfaction and ensure quality patient care during EHR transitions.

Sections du résumé

BACKGROUND
Adoption of electronic health care records (EHRs) has proliferated since 2000. While EHR transitions are widely understood to be disruptive, little attention has been paid to their effect on health professions trainees' (HPTs) ability to learn and conduct work. Veterans Health Administration's (VA) massive transition from its homegrown EHR (CPRS/Vista) to the commercial Oracle Cerner presents an unparalleled-in-scope opportunity to gain insight on trainee work functions and their ability to obtain requisite experience during transitions.
OBJECTIVE
To identify how an organizational EHR transition affected HPT work and learning at the third VA go-live site.
DESIGN
A formative mixed-method evaluation of HPT experiences with VHA's EHR transition including interviews with HPTs and supervisors at Chalmers P. Wylie VA Outpatient Clinic in Columbus, OH, before (~60 min), during (15-30 min), and after (~60 min) go-live (December 2021-July 2022). We also conducted pre- (March 2022-April 2022) and post-go live (May 2022-June 2022) HPT and employee surveys.
PARTICIPANTS
We conducted 24 interviews with HPTs (n=4), site leaders (n=2), and academic affiliates (n=2) using snowball sampling. We recruited HPTs in pre- (n=13) and post-go-live (n=10) surveys and employees in pre- (n=408) and post-go-live (n=458) surveys.
APPROACH
We conducted interviews using a semi-structured guide and grounded prompts. We coded interviews and survey free text data using a priori and emergent codes, subsequently conducting thematic analysis. We conducted descriptive statistical analysis of survey responses and merged interview and survey data streams.
KEY RESULTS
Our preliminary findings indicate that the EHR transition comprehensively affected HPT experiences, disrupting processes from onboarding and training to clinical care contributions and training-to-career retention.
CONCLUSIONS
Understanding HPTs' challenges during EHR transitions is critical to effective training. Mitigating the identified barriers to HPT training and providing patient care may lessen their dissatisfaction and ensure quality patient care during EHR transitions.

Identifiants

DOI: 10.1007/s11606-023-08283-4 PMID: 37798576 PMC: PMC10593679
pubmed: 37798576
doi: 10.1007/s11606-023-08283-4
pii: 10.1007/s11606-023-08283-4
pmc: PMC10593679
doi:

Types de publication

Journal Article Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

1031-1039

Subventions

Organisme : Quality Enhancement Research Initiative
ID : PEC 21-280

Informations de copyright

© 2023. The Author(s).

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Auteurs

Ellen A Ahlness (EA)

Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA. Ellen.A.AhlnessAbdulmuminov@va.gov.
ORCID: 0000-0002-3324-3135

Brianne K Molloy-Paolillo (BK)

Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.

Julian Brunner (J)

Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care, Los Angeles, CA, USA.

Sarah L Cutrona (SL)

Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.
Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.

Bo Kim (B)

Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.

Erin Matteau (E)

VA Office of Academic Affiliations, Washington, DC, USA.

Seppo T Rinne (ST)

Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.
The Pulmonary Center, Department of Medicine, Boston University, Boston, MA, USA.

Edward Walton (E)

VA Office of Academic Affiliations, Washington, DC, USA.

Edwin Wong (E)

Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA.
University of Washington School of Public Health, Seattle, WA, USA.

George Sayre (G)

Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle. VA Medical Center, Seattle, WA, USA.
University of Washington School of Public Health, Seattle, WA, USA.

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