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

Gemmae Fix, PhD (VA Bedford) & Jessica Davila, PhD (VA Houston)

Enhancing PROVEN’s understanding of the Veteran Experience during the Cerner Transition (PROVEN VET)

Engage Veteran stakeholders to identify areas of importance associated with the Cerner implementation and develop a Veteran-informed research agenda related to EHR modernization.

Explore Veteran experiences of care at a Cerner Millennium VA facility to identify patient needs and gaps in the current transition process.

Qualitative methods:

Listening sessions

Semi-structured interviews

Data Sources:

Veterans

Status: Funded

Funding Source: PROVEN Responsive Pilot Project

Operations Partner: Veteran Experience Office

• Veteran perspective
• listening sessions
• qualitative interviews

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) & George Sayer, PsyD, MS (VA Puget Sound)

Strengthening Cerner Implementation for Health Professions Trainees to Optimize Learning and Reinforce Veteran Care (SCHOLAR)

Identify and understand HPTs’ EHR transition challenges and needs.

Design a prototype intervention to improve EHR transitions for HPTs.

Assess prototype intervention acceptability, feasibility, and impact on EHR use.

Mixed methods:

Semi-structured interivews

Longitudinal surveys

EHR log data

Data Sources:

Qualitative interviews

Surveys

Cerner Lights On

Status: Funded

Funding Source: QUERI Partnered Evaluation Initiative (PEI)

Operations Partner:

Office of Academic Affiliations (OAA)

Office of the Functional Champion (OFC)

Office of Electronic Health Record Modernization (OEHRM)

• electronic health record
• implementation
• medical education

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: In Progress

Funding Source: QUERI Partnered Evaluation Initiative (PEI)

Operations Partner:

Office of the Functional Champion (OFC)

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:

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