Ball Sherry L, Rucci Justin M, Molloy-Paolillo Brianne K, Cutrona Sarah L, Brunner Julian, Mohr David C, Kim Bo, Moldestad Megan, Zepeda E David, Orlander Jay D, Anderson Ekaterina, Cohen-Bearak Adena, Helfrich Christian D, Sayre George, Rinne Seppo T
VA Northeast Ohio Healthcare System, Cleveland, OH 44106, United States.
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA 01730, United States.
JAMIA Open. 2024 Jul 15;7(3):ooae067. doi: 10.1093/jamiaopen/ooae067. eCollection 2024 Oct.
The Department of Veterans Affairs (VA) is transitioning from its legacy electronic health record (EHR) to a new commercial EHR in a nationwide, rolling-wave transition. We evaluated clinician and staff experiences to identify strategies to improve future EHR rollouts.
We completed a convergent mixed-methods formative evaluation collecting survey and interview data to measure and describe clinician and staff experiences. Survey responses were analyzed using descriptive statistics; interview transcripts were coded using a combination of a priori and emergent codes followed by qualitative content analysis. Qualitative and quantitative findings were compared to provide a more comprehensive understanding of participant experience. Employees of specialty and primary care teams at the first nationwide EHR transition site agreed to participate in our study. We distributed surveys at 1-month pre-transition, 2 months post-transition, and 10 months post-transition to each of the 68 identified team members and completed longitudinal interviews with 30 of these individuals totaling 122 semi-structured interviews.
Interview participants reported profoundly disruptive experiences during the EHR transition that persisted at 1-year post implementation. Survey responses indicated training difficulties throughout the transition, and sharp declines ( ≤ .05) between pre- and post-go-live measures of EHR usability and increase in EHR burden that were perceived to be due in part to system inefficiencies, discordant positive messaging that initially ignored user challenges, and inadequate support for and attention to ongoing EHR issues. Participants described persistent high levels of stress associated with these disruptions.
Our findings highlight strategies to improve employee experiences during EHR transitions: (1) working with Oracle Cerner to resolve known issues and improve usability; (2) role-based training with opportunities for self-directed learning; (3) peer-led support systems and timely feedback on issues; (4) messaging that responds to challenges and successes; and (5) continuous efforts to support staff with issues and address clinician and staff stress and burnout.
Our findings provide relevant strategies to navigate future EHR transitions while supporting clinical teams.
美国退伍军人事务部（VA）正在全国范围内以滚动式推进的方式，从其传统电子健康记录（EHR）系统过渡到新的商用EHR系统。我们评估了临床医生和工作人员的体验，以确定改善未来EHR系统推广的策略。
我们完成了一项融合式混合方法的形成性评估，收集调查和访谈数据，以衡量和描述临床医生和工作人员的体验。调查回复采用描述性统计进行分析；访谈记录使用先验编码和新出现的编码相结合的方式进行编码，随后进行定性内容分析。对定性和定量研究结果进行比较，以更全面地了解参与者的体验。首个全国性EHR系统过渡站点的专科和初级保健团队的员工同意参与我们的研究。我们在过渡前1个月、过渡后2个月和过渡后10个月，向68名确定的团队成员中的每一位发放了调查问卷，并对其中30人进行了纵向访谈，共进行了122次半结构化访谈。
访谈参与者报告称，在EHR系统过渡期间经历了严重的干扰，这种干扰在实施后1年仍持续存在。调查回复表明，在整个过渡过程中都存在培训困难，EHR系统可用性的上线前和上线后指标之间急剧下降（≤0.05），且EHR负担增加，部分原因被认为是系统效率低下、最初忽视用户挑战的不一致的积极信息传递，以及对持续的EHR问题缺乏足够的支持和关注。参与者描述了与这些干扰相关的持续高水平压力。
我们的研究结果突出了改善EHR系统过渡期间员工体验的策略：（1）与甲骨文Cerner公司合作解决已知问题并提高可用性；（2）基于角色的培训以及自我导向学习的机会；（3）由同行主导的支持系统以及对问题的及时反馈；（4）回应挑战和成功的信息传递；（5）持续努力为有问题的员工提供支持，并解决临床医生和工作人员的压力及职业倦怠问题。
我们的研究结果提供了相关策略，以指导未来的EHR系统过渡，同时为临床团队提供支持。
