Lead/Presenter: Julian Brunner, COIN - Los Angeles
All Authors: Brunner J (Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles CA), Mak S (Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles CA) Cogan A (Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles CA) Miake-Lye I (Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles CA)
Objectives:
Best practices for electronic health record (EHR) EHR transitions are rarely "one size fits all" and frequently vary according to the distinct characteristics of each facility. But which facility characteristics most inform tailoring of implementation strategies, and which can help identify facilities that are most likely to struggle? We conducted this project to identify key facility-level factors that make EHR transitions easier or harder, and that can inform the tailoring of implementation strategies. The objectives were: a) To identify and synthesize the existing body of literature on EHR-to-EHR transitions; b) to identify existing tools or metrics to measure organizational (facility-level) factors during EHR-to-EHR transitions, and c) to develop measures of high-priority organizational factors influencing EHR transitions.
Methods:
We first conducted a systematic review, updating the searches from two recent reviews in PubMed through 7/19/2021. Included publications described original data about transitions from one EHR to another. We abstracted data on study design, setting, sample size, EHR vendors, dates of transition and data collection, outcomes reported, and key findings. Our review did not identify any tools or metrics to measure organizational factors during EHR-to-EHR transitions. As such, we conducted semi-structured interviews with content area experts to identify key factors underrepresented in published reports as well as potential data sources for factors. We then convened an expert panel, using a modified Delphi process to identify high-priority organizational factors influencing EHR transitions.
Results:
Our searches identified 423 titles for review. Of these, we included 38 in our review. We synthesized descriptions of transitions from a legacy EHR to a new EHR from included publications, grouping articles by topical areas: quality of care (n = 5), medication safety (n = 5), workflow/productivity (n = 5), patient satisfaction (n = 2), data-related issues (n = 8), provider perspectives (n = 9), and other topics (n = 5). Key informant interview (n = 8) and expert panel participants (n = 9) identified 5 domains (structure of facility, receptive context, tension for change, dedicated resources, and existing communication and networks) of key organizational factors in EHR transitions. These 5 domains encompassed 29 specific factors, such as informatics staffing, employee psychological safety, and health IT governance. In addition, the panel identified key considerations for measuring/operationalizing organizational factors.
Implications:
While the existing literature on EHR-to-EHR transitions did not identify any tools or measures related to organizational factors, it did highlight the need for routinely-collected data throughout the transition process. Many of the documented outcomes showed declines or worsened performance early in the transition, with improvements or recovery over time. The VA’s transition represents a national scale that allows for an unprecedented degree of inter-site comparison and analysis. Future work should develop approaches to measurement and analysis to best capture insights from this unique transition.
Impacts:
Obtaining regularly-collected data about key factors influencing EHR transitions in the short and long term will be crucial to success, and important for the purposes of planning and tailoring change management approaches to fit local needs. The VA’s transition represents a unique opportunity to identify key influential factors and use them to optimize implementation effectiveness.