Abstract 28: Implementation of a Nationwide Health IT System for Cardiac Cath Labs in the VA Hospital System: the CART Program

Abstract

Background. Despite growing availability of electronic health records (EHR) and interest in using health IT (HIT) applications within EHR’s to support clinical care, little is know about the factors associated with successful implementation of HIT applications. We evaluated the national implementation of the VA Clinical Assessment, Reporting and Tracking (CART) HIT system. Methods. The VA CART system is a clinical application embedded in the VA’s EHR that supports point of care procedure reports based on American College of Cardiology data standards, device surveillance, and real-time national quality of care oversight. CART was successfully implemented at the 75 VA cardiac catheterization hospitals, and remains in full clinical use for all sites. We evaluated the overall time for implementation and the four consecutive stages in the process (Initiation, Installation, Training, Clinical Use). We used Cox Proportional Hazards regression to evaluate the associations between full implementation time and urban location, academic affiliation, geographic region, size, and whether implementation was initiated before or after a memo of senior leadership support was issued. Results. CART was implemented at the 75 VA hospitals over 6.25 years, with a pattern of diffusion typical for successful HIT implementation based on prior studies (Figure 1). Median time per site for implementation was 14 ± 17 months (IQR 7, 33). Initiation, Installation, and Training stages exhibited relatively little variability in duration per site (Md = 2 ± 9, 4 ± 7, 2 ± 6 mos), while there was higher variability in the time required for full Clinical Use (5 ± 11; IQR 2, 14). In multivariable analysis, sites that initiated implementation after the senior leadership statement had significantly faster implementation (HR 0.49, 95% CI 0.29-0.83, P=0.008). Conclusions. The CART system was successfully implemented nationwide, achieving full use in the 75 VA cardiac cath labs. The final stage, full Clinical Use, took the longest and was most variable by site. These results reinforce that successful HIT implementation does not end with technical installation and training, and must support clinical use as part of routine care delivery. Our results also reinforce the importance of senior leadership support for HIT implementation to support clinical care. [[Unable to Display Character:  ]]