Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3062 — Barriers to the Adoption of VA Care Management Software

Nebeker JR (TREP-Salt Lake City) , Weir CW (TREP-Salt Lake City), Hicken B (TREP-Salt Lake City), Sauer

Objectives:
Care Management software (CM), the first component for the new, Java-hosted electronic medical record, included novel features such as “to-do-list” task management and icon-enhanced alert processing. Features of the legacy Computerized Patient Record System (CPRS) include electronic alerts, orders, results, and notes. Because of limited initial CM use, we aimed to identify perceived barriers to its adoption.

Methods:
Using implementation plans submitted to VHA Central Office by all 132 VHA sites, structured inclusion criteria were used to select sites that exhibited high interest in and preparation for CM implementation. Task creation, a quantitative measure of adoption, was identified by local M queries. Three interviewers conducted semi-structured, on-site interviews with users. Using grounded theory, three investigators iteratively grouped user comments into major thematic areas regarding perceived barriers to adoption and task-related actions.

Results:
42 sites met or exceeded inclusion criteria; 14 obtained IRB approval and enrolled in the study. Each site oriented 8-10 providers. During the last 7 months of 2004, users created a median of 17 tasks (range 0-115 tasks) per site. Fewer than 5 individuals at all sites were using the software at the end of 2004. Major perceived barriers to adoption included difficulty manipulating patient lists in CM; duplicative alert processing in CPRS and CM; minimal training in the new functionality of CM; need to return to CPRS to complete processing of alerts or tasks reviewed in CM; inability to identify a task with a person in CM; superiority of the unsigned-note and cosigned-note workarounds in CPRS for task management. Of 60 user-identified task-related actions, CM addressed 11 whereas CPRS addressed 46. Prominent shortcomings of CM involved lack of task-tracking and communication functionality—especially in task hand-off and task resolution.

Implications:
Richer task-processing and comparable alert-processing functionality in CPRS presented important barriers to the adoption of CM software.

Impacts:
Future efforts to facilitate task management in VA software should move beyond the limited view of clinical tasks reflected by the to-do-check-list approach; incorporate improved sequencing, tracking and communication functionality; and more tightly integrate these functions with CPRS.