Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA.
Medical Service, VA Boston Healthcare System, Boston, MA, USA.
J Gen Intern Med. 2023 Oct;38(Suppl 4):991-998. doi: 10.1007/s11606-023-08282-5. Epub 2023 Oct 5.
Electronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate and mitigate such disruptions. Veterans Affairs (VA) is undergoing a large-scale transition from its homegrown EHR (CPRS/Vista) to a commercial EHR (Cerner), creating a unique opportunity of shedding light on large-scale EHR-to-EHR transition challenges.
To explore one facet of the organizational impact of VA's EHR transition: its implications for employees' roles and responsibilities at the first VA site to implement Cerner Millennium EHR.
As part of a formative evaluation of frontline staff experiences with VA's EHR transition, we conducted brief (~ 15 min) and full-length interviews (~ 60 min) with clinicians and staff at Mann-Grandstaff VA Medical Center in Spokane, WA, before, during, and after transition (July 2020-November 2021).
We conducted 111 interviews with 26 Spokane clinicians and staff, recruited via snowball sampling.
We conducted audio interviews using a semi-structured guide with grounded prompts. We coded interview transcripts using a priori and emergent codes, followed by qualitative content analysis.
Unlike VA's previous EHR, Cerner imposes additional restrictions on access to its EHR functionality based upon "roles" assigned to users. Participants described a mismatch between established institutional duties and their EHR permissions, unanticipated changes in scope of duties brought upon by the transition, as well as impediments to communication and collaboration due to different role-based views.
Health systems should anticipate substantive impacts on professional workflows when EHR role settings do not reflect prior workflows. Such changes may increase user error, dissatisfaction, and patient care disruptions. To mitigate employee dissatisfaction and safety risks, health systems should proactively plan for and communicate about expected modifications and monitor for unintended role-related consequences of EHR transitions, while vendors should ensure accurate role configuration and assignment.
电子健康记录 (EHR) 的过渡越来越普遍，而且往往具有高度的破坏性。我们必须从过去的经验中吸取教训，预测并减轻这种破坏。退伍军人事务部 (VA) 正在从其内部开发的 EHR (CPRS/Vista) 向商业 EHR (Cerner) 进行大规模过渡，这为深入了解大规模 EHR 到 EHR 过渡挑战提供了独特的机会。
探讨 VA 的 EHR 过渡对组织的影响之一：对第一家实施 Cerner Millennium EHR 的 VA 站点员工角色和职责的影响。
作为对 VA 的 EHR 过渡前线员工经验进行形成性评估的一部分，我们在过渡前、过渡中和过渡后（2020 年 7 月至 2021 年 11 月）对华盛顿州斯波坎曼 - 格兰德斯塔夫 VA 医疗中心的临床医生和工作人员进行了简短（约 15 分钟）和全长访谈（约 60 分钟）。
我们通过滚雪球抽样的方式，对斯波坎的 26 名临床医生和工作人员进行了 111 次访谈。
我们使用带有扎根提示的半结构化指南进行音频访谈。我们使用先验和新兴代码对访谈记录进行编码，然后进行定性内容分析。
与 VA 的前一个 EHR 不同，Cerner 根据分配给用户的“角色”对其 EHR 功能施加了额外的限制。参与者描述了既定机构职责与其 EHR 权限之间的不匹配，过渡带来的职责范围的意外变化，以及由于基于角色的不同观点而导致的沟通和协作障碍。
当 EHR 角色设置与之前的工作流程不匹配时，医疗系统应该预料到对专业工作流程的实质性影响。此类更改可能会增加用户错误、不满和患者护理中断的风险。为了减轻员工的不满和安全风险，医疗系统应主动规划和沟通预期的修改，并监测 EHR 过渡的意外角色相关后果，而供应商应确保准确的角色配置和分配。
