VA Information Resource Center Edward Hines, Jr. VA Hospital, Hines, IL 60141, USA.
Med Care. 2013 Mar;51(3 Suppl 1):S6-12. doi: 10.1097/MLR.0b013e3182884509.
The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has demonstrated how implementation science can enhance the quality of health care. During this time an increasing number of implementation research projects have developed or utilized health information technology (HIT) innovations to leverage the VA's electronic health record and information systems.
To describe the HIT approaches used and to characterize the facilitators and barriers to progress within implementation research projects in the VA QUERI program.
Nine case studies were selected from among 88 projects and represented 8 of 14 HIT categories identified. Each case study included key informants whose roles on the project were principal investigator, implementation science and informatics development.
We conducted documentation analysis and semistructured in-person interviews with key informants for each of the 9 case studies. We used qualitative analysis software to identify and thematically code information and interview responses.
: Thematic analyses revealed 3 domains or pathways critical to progression through the QUERI steps. These pathways addressed: (1) compliance and collaboration with information technology policies and procedures; (2) operating within organizational policies and building collaborations with end users, clinicians, and administrators; and (3) obtaining and maintaining research resources and approvals.
Sustained efforts in HIT innovation and in implementation science in the Veterans Health Administration demonstrates the interdependencies of these initiatives and the critical pathways that can contribute to progress. Other health care quality improvement efforts that rely on HIT can learn from the Veterans Health Administration experience.
退伍军人事务部（VA）质量增强研究倡议（QUERI）已经展示了实施科学如何提高医疗保健质量。在此期间，越来越多的实施研究项目已经开发或利用了医疗信息技术（HIT）创新，以利用 VA 的电子健康记录和信息系统。
描述在 VA QUERI 计划中实施研究项目中使用的 HIT 方法，并描述在这些项目中取得进展的促进因素和障碍。
从 88 个项目中选择了 9 个案例研究，代表了确定的 14 个 HIT 类别中的 8 个。每个案例研究都包括关键信息提供者，他们在项目中的角色是主要研究者、实施科学和信息学开发。
我们对 9 个案例研究中的每个案例研究都进行了文档分析和半结构化的现场访谈。我们使用定性分析软件来识别和主题编码信息和访谈回复。
主题分析揭示了 3 个关键领域或途径，这些途径对于通过 QUERI 步骤至关重要。这些途径包括：（1）遵守和合作信息技术政策和程序；（2）在组织政策内运作，并与最终用户、临床医生和管理人员建立合作关系；（3）获得和维持研究资源和批准。
退伍军人健康管理局在医疗信息技术创新和实施科学方面的持续努力展示了这些倡议的相互依存关系，以及可以促进进展的关键途径。其他依赖医疗信息技术的医疗保健质量改进工作可以从退伍军人健康管理局的经验中学习。
