Abstract
BackgroundThe Veterans Health Administration (VA) has invested significant resources in designing and implementing a comprehensive electronic health record (EHR) that supports clinical priorities. EHRs in general have been difficult to implement, with unclear cost-effectiveness. We describe VA clinical personnel interactions with and evaluations of the EHR.MethodsAs part of an evaluation of a quality improvement initiative, we interviewed 72 VA clinicians and managers using a semi-structured interview format. We conducted a qualitative analysis of interview transcripts, examining themes relating to participants' interactions with and evaluations of the VA EHR.ResultsParticipants described their perceptions of the positive and negative effects of the EHR on their clinical workflow. Although they appreciated the speed and ease of documentation that the EHR afforded, they were concerned about the time cost of using the technology and the technology's potential for detracting from interpersonal interactions.ConclusionsVA personnel value EHRs' contributions to supporting communication, education, and documentation. However, participants are concerned about EHRs' potential interference with other important aspects of healthcare, such as time for clinical care and interpersonal communication with patients and colleagues. We propose that initial implementation of an EHR is one step in an iterative process of ongoing quality improvement.
Highlights
The Veterans Health Administration (VA) has invested significant resources in designing and implementing a comprehensive electronic health record (EHR) that supports clinical priorities
Recent research and national healthcare policy discussions have highlighted the potential of electronic health records (EHRs) to improve quality and efficiency [1,2,3] and potentially to reduce healthcare costs [4,5]
Awareness of how end-users interact with the EHR is essential for successful implementation and improvement of the informatics system
Summary
The Veterans Health Administration (VA) has invested significant resources in designing and implementing a comprehensive electronic health record (EHR) that supports clinical priorities. The Plan-Do-Study-Act cycle (PDSA) provides a useful framework for evaluating system change [16], and can be used to conceptualize EHR implementation Informatics systems such as the EHR are designed and built to meet clinical needs (in the ‘Plan’ phase). The EHR is implemented (in the ‘Do’ phase), and endusers provide feedback (during the ‘Study’ phase) that drives further refinement of the informatics system (during the ‘Act’ phase) In this framework, feedback from end-users is essential to make the EHR more acceptable to clinicians and more useful to the organization. The ITSA model [17] likewise describes a recursive relationship in which interactions between health IT and the larger clinical environment shape development of both the EHR and the larger environment In both models, awareness of how end-users interact with the EHR is essential for successful implementation and improvement of the informatics system. In an article describing the implementation of the Veterans Health Administration’s (VA) EHR, Evans and colleagues identify an ‘iterative partnership’ between users and developers as central to the success of EHR implementation [18]
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