1128 — Qualitative Assessment of VA Telegenomic Clinic Implementation

Lerner B, CHOIR; McIntosh N, CHOIR; Meterko M, CHOIR; Wiltsey-Stirman S, VABHS; Venne V, Salt Lake City VA;

Objectives:
Since 2010, Genomic Medicine Service (GMS) has been working to create a VA-wide Telehealth Genomics program in order to maximize Veteran access to genomic services. Participating facilities must first establish an inter-facility Telegenomics clinic including informatics infrastructure allowing GMS providers read/write access to the facility's CPRS records. Experience with the first 40 adopters showed significant variation in a facility's ability to expeditiously implement these clinics. The goal of this study was to evaluate the implementation process in those facilities and identify best practices facilitate more efficient adoption of Telegenomics clinics as the program moves forward.

Methods:
We ranked 40 facilities on implementation efficiency based on subjective and objective criteria, and selected three "high" and two "low" facilities as sites for this formative evaluation study. We interviewed Facility Telehealth Coordinators (FTC), Telehealth technicians, Clinic Application Coordinators, Information Privacy Officers, Chiefs of Pathology, and referring providers at each facility about their implementation experiences. Several GMS staff were also interviewed. Data were analyzed using deductive coding based on the Consolidated Framework for Implementation Research (CFIR) domains. Concepts and themes related to implementation facilitators and barriers were identified, as were recommendations to improve the process.

Results:
We conducted 43 interviews. At the efficient facilities, FTCs had strong project management skills and understood the sequence of steps and roles of people needed for clinic implementation. They also relied heavily on well-established relationships and good communication with the relevant departments. Also, clinicians and the laboratory director at these facilities were advocates for Telegenomics program. FTCs from inefficient facilities had limited prior inter-department relationships and communication skills, and/or lacked an overarching understanding of the implementation process.

Implications:
The efficiency of implementing Telegenomics clinics would be improved by providing FTCs with tools to better manage the complex inter-facility clinic implementation process, including guidance for the development of inter-departmental relationships and channels of communication.

Impacts:
Improving the efficiency with which Telegenomics clinics are implemented will reduce the gap between patient need and access for genomic services in the VA.