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Health Services Research & Development

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Projects

Coordinating Hub to Promote Research Optimizing Veteran-Centric Electronic Health Record (EHR) Networks (PROVEN) logo

PROVEN-Funded Rapid Pilot Projects

Kristina Cordasco. Impacts of Cerner Millennium on communication across specialty care referrals.

Kristen Gray & Kristine Lynch. Identifying clinical informatics solutions to coordinating mammograms performed outside of VA.

Sarah Krein. Understanding the impact of the EHR transition on VA inpatient nursing care.

Jeremy Shelton & Julian Brunner. Formative evaluation of EHRM Councils.

Newly Funded EHRM Projects

(all projects are VA-funded unless otherwise noted)

Isomi Miake-Lye & Julian Brunner. Identifying and Measuring Key Organizational Factors in EHR Transitions

Project Registry

PI, Study Title & Aims

Methods Overview

Funding & Partners

Keywords

Neetu Chawla, PhD (VA Greater LA)

Licensed Independent Practitioners (LIP) call center evaluation

  • Assess VISN stakeholder and frontline primary care staff perceptions of clinical contact centers (CCC), integration of licensed independent practitioners (LIP) into CCC, EHRM, and use of virtual care

Qualitative methods:

  • Interviews with VISN stakeholders, frontline primary care providers, and RN care managers

Data Sources:

  • Primary Data Collection

Status: Funded

Funding Source: Office of Connected Care/ Office of Nursing Services MOU

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • clinical contact center
  • nurse advice lines
  • tele-urgent care
  • telemedicine
  • virtual care

Victoria Church, RN, MS, CNS (VA Portland)

VA EHRM Essential Clinical Dataset (ECD) Value Realization

  • Identify time difference for nurse to complete Adult Admission Summary pre and post EHRM Cerner Go-Live
  • Identify time dedicated to each nursing activity per shift pre and post EHRM Go-Live

Mixed-methods:

  • Pre-post comparison of ‘time to complete’ EHR data
  • Observational assessment

Data Sources:

  • EHR Data
  • Primary data collection

Status: Funded

Funding Source: Office of Nursing Services

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • nursing documentation
  • time to chart
  • transition to EHRM

Kristina Cordasco, MD, MPH, MSHS (VA Greater LA)

Impacts of Cerner Millennium on communication across specialty care referrals

  • Assess Millennium’s referral request process for adherence with recommended best practices
  • Measure frequency/types of referral process delays or failures during transition and full implementation, compare to pre-Millennium (CPRS)
  • Explore primary and specialty care providers’ insights/perceptions of specialty care referral request process

Mixed-methods:

  • Quantitative interrupted time series
  • Qualitative document review
  • Qualitative stakeholder interviews

Data Sources:

  • VA Corporate Data Warehouse (CDW)

Status: Funded

Funding Source: PROVEN Rapid Pilot Project

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • referrals
  • specialty care
  • mixed-methods
  • provider interviews

Stefanie Deeds, MD (VA Puget Sound)

Impact of EHRM on clinical efficiency, productivity, and patient access in primary care

  • Evaluate impact of EHRM implementation in primary care clinics on provider workflow and patient access

Quantitative methods:

  • Observations of clinical encounters using time-motion software

Data Sources:

  • Primary data collection

Status: Funded

Funding Source: Primary Care Analytics Team

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • observation

Stefanie Deeds, MD (VA Puget Sound) & Scott Hagan, MD (VA Puget Sound)

Impact of EHRM on quality outcomes of primary care patients

  • Does EHRM improve quality of care and performance on national performance metrics?

Quantitative methods:

  • Pre-post tracking of quality measures

Data Sources:

  • Quality indicators – EPRP and EQM

Status: Funded

Funding Source: Primary Care Analytics Team

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • quality of care
  • primary care
  • cancer screening
  • chronic disease management

Stefanie Deeds, MD (VA Puget Sound) & Scott Hagan, MD (VA Puget Sound)

Impact of EHRM on primary care provider workflow during office visits

  • How does EHRM change how providers use computer software during office visits?

Qualitative methods:

  • Observations

Data Sources:

  • Primary data collection

Status: Funded

Funding Source: Primary Care Analytics Team

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • workflow
  • productivity
  • primary care

Stefanie Deeds, MD (VA Puget Sound) & Scott Hagan, MD (VA Puget Sound)

Impact of EHRM on safety of primary care

  • Does EHRM increase risk to patients and raise safety concerns?

Quantitative methods:

  • Tracking of abnormal test follow-up results.

Development of novel trigger tracking tools to identify clinic sites at risk for unsafe EHRM transition. 

Data Sources:

  • CDW and manual chart review

Status: Funded

Funding Source: Primary Care Analytics Team

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • safety
  • medication safety
  • abnormal results
  • communication

Kristen Gray, PhD (VA Puget Sound) & Kristine Lynch, PhD (VA Salt Lake City)

Identifying clinical informatics solutions to coordinating mammograms performed outside of VA

  • Identify common barriers and facilitators to coordination of external mammograms (referred to community)
  • Quantify the availability, format, and location of key coordination variables in CPRS
  • Identify features and deficits relating to external care coordination within the Cerner EHR at non-VA healthcare system(s) currently using a Cerner EHR.

Mixed-methods:

  • Natural language processing
  • Qualitative provider interviews
  • Medical record review

Data Sources:

  • EHR (CPRS/VistA/ Cerner Millennium)
  • VA Corporate Data Warehouse (CDW)
  • Joint Legacy Viewer (JLV)
  • VistAWeb
  • VHA Support Service Center (VSSC)
  • Primary data collection

Status: Funded

Funding Source:  PROVEN Rapid Pilot Project

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • mixed-methods
  • natural language processing
  • provider interviews
  • mammography
  • care coordination

Sarah Krein, PhD, RN (VA Ann Arbor)

Understanding the impact of the EHR transition on VA inpatient nursing care

  • Develop preliminary insights for assessing impact of EHR transition on inpatient nursing care
  • Explore development of EHR-related workarounds or process adaptations by inpatient nurses
  • Adapt and test feasibility of using previously developed time and motion workflow assessment tool to systematically assess inpatient nursing activities during EHR transition

Sequential multi-method qualitative design:

  • Direct observation
  • Shadowing
  • Focus groups

Data Sources:

  • Primary data collection

Status: Funded

Funding Source: PROVEN Rapid Pilot Project

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • nursing
  • qualitative methods
  • inpatient care
  • rapid analysis
  • descriptive content analysis

Matt Maciejewski, PhD (VA Durham) & Matt Samore, MD (VA Puget Sound)

Qualitative interviews of non-VA Cerner adopters to understand data curation needs

  • Understand barriers and facilitators to Cerner transition
  • Understand data curation and patient safety challenges associated with the Cerner transition in non-VA health systems

Qualitative methods:

  • Interviews

Data Sources:

  • Primary data collection

Status: Funded

Funding Source: QUERI

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • electronic health record
  • qualitative interview

Isomi Miake-Lye, PhD (VA Greater LA) & Julian Brunner, PhD, MPH (VA Greater LA)

Identifying and Measuring Key Organizational Factors in EHR Transitions

  • Elicit expert stakeholder perspectives on organizational factors influencing EHR transitions identified by a systematic review and qualitative interviews of key stakeholders
  • Use a modified Delphi expert panel process to reach consensus on high-priority organizational factors influencing EHR transitions and develop recommendations for how to best capture data related to these factors
  • Develop and pre-test a facility-level survey assessing key characteristics to inform EHR transitions in VA

Mixed Methods:

  • Literature synthesis
  • Interviews
  • Virtual expert panel (Delphi approach)
  • Survey development

Data Sources:

  • Published literature
  • Primary data collection

Status: Funded

Funding Sources: PROVEN Rapid Pilot Project

  • Electronic health record transition
  • organizational factors
  • implementation science
  • survey development

Seppo Rinne, MD, PhD (VA Boston) & George Sayer, PsyD, MS (VA Puget Sound)

Integrating rapid cycle evaluation to improve Cerner implementation

  • Conduct a formative evaluation to identify implementation strategies that support EHRM
  • Develop consensus on strategies to optimize EHRM integration
  • Pilot test a tailored multicomponent strategy to improve EHRM outcomes

Mixed methods:

  • Observation
  • Surveys
  • Interviews
  • Process maps
  • Delphi process

Data Sources:

  • Continuing Review Questionnaire data
  • Qualitative interviews

Status: Funded

Funding Source: OEHRM/QUERI PEI

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • evaluation
  • change management
  • implementation strategies
  • continuous improvement

Seppo Rinne, MD, PhD (VA Boston)

Physician experience with EHR transformation

  • Explore non-VA experiences with recent EHR transformations
  • Prospectively examine physician burnout in VA
  • Determine the impact of EHR transformations on turnover and turnover intent

Pragmatic qualitative methods:

  • Qualitative Interviews with Non-VA Providers
  • Secondary analysis of VA All Employee Survey data

Data Sources:

  • Primary data collection
  • VA All Employee Survey data

Status: Funded

Funding Source: American Medical Association Foundation

Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

  • evaluation
  • change management
  • implementation strategies
  • continuous improvement

Jeremy Shelton, MD, MPH (VA Greater LA) & Julian Brunner, PhD (VA Greater LA)

Formative Evaluation of EHRM Councils

  • Characterize EHRM Council structure, processes, lessons learned with eye to informing improved Council effectiveness, efficiency and sustainability

Qualitative methods:

  • Interviews
  • Document review

Data Sources:

  • Administrative data (e.g. summary reports, council charters, council membership)

  • Status: In progress

    Funding Source:  PROVEN Rapid Pilot Project

    Operations Partner: Office of Electronic Health Record Modernization (OEHRM)

    • qualitative interviews
    • document review
    • stakeholder council
    • process evaluation

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