Access includes many dimensions, such as specialty, time, place, and care modality (e.g., e-consultation). It includes effects of scheduling of appointments. How has appointment scheduling changed? What challenges remain, and how should they be addressed?
What informatics workforce needs have arisen as a result of EHR modernization, in research and practice? What organizational practices are most effective at transforming the VA’s workforce to meet the new EHR environment?
The process of research, methodology, and types of research questions that can be answered may change profoundly with EHR modernization. How accurate and reliable is using the EHR to measure processes and clinical outcomes of care? How accessible and “usable” are EHR data, for conducting health services research and clinical research? How is research affected, what are the advantages, and how can challenges be met?
How well is the EHR capturing, with validity and reliability, important factors in care? What is the extractability and analyzability of data, and the extent of backward compatibility with legacy programs or systems that may require ongoing use?
How does time spent with the EHR change during and following EHR modernization? What can be done to increase the efficiency of documentation, and what is the impact of such changes? How much time do healthcare providers spend in direct patient care vs. EHR-related tasks (documentation, ordering, etc.)? How much effort is needed for EHR-related tasks such as ordering and accessing outside records? Which EHR-related tasks could be shifted to other members of the care team? How can be we best measure time spent on EHR-related tasks? How can we use the EHR to drive improvements in efficiency?
How has EHR modernization affected clinical workflow standardization, and what are the effects of any such standardization? Throughout the EHR modernization, how have EHR governance structures influenced the ability to scale and spread EHR-based innovations? How have they influenced the ability of facilities and networks to adapt to local demands? What are the characteristics of effective EHR governing bodies (e.g., clinical informatics committees)?
With the MISSION Act, the need to “close the loop” and ensure bidirectional information exchange is greater than ever. How are professionals interacting with each other via the EHR, inside and outside VA, in teamwork and consultations?
To what extent are patient-facing functions, imaging studies, and outside episodes of care integrated with the Veteran’s medical record? How do technologies involved in information exchange affect coordination of care, and how can they be leveraged to improve coordination? To what extent is EHRM supporting the need for health information exchange and interoperability of systems inside and outside VA? How are VA clinicians accessing non-VA information, and how can such access be improved? How do the quality and completeness of community-based health information exchange affect the time that clinicians and others in the VA must spend to access non-VA data? How well do methods for accessing and using non-VA information in the VA support care coordination efforts within the VA and externally with non-VA providers?
How useful, usable, and learnable are the systems that are emerging through EHRM? How do issues of human factors and human-computer interaction relate to patient safety, burnout, cognitive load, and cognitive function?
EHR modernization may make some information more findable and other information less so. To what extent do users change their information foraging habits according to the EHR system? Where do they look for information, in what order, and how long do they spend in each place before moving on, or quitting? How can the foraging process be improved? How can PACT team structures or roles better support information foraging needs? How does the modernization reduce burden on clinicians to search for information about common medical conditions?
What is the effect of EHRM on innovation, and capacity for innovation, with the EHR? In what ways are innovations, or ideas about them, surfacing, being shared, and being pursued? How are clinicians, administrators, researchers, and others interacting with technical developers in these pursuits? How can such partnerships be more fruitful? How do such activities and capabilities vary by site?
How is EHRM affecting VA as a Learning Health System? Lessons learned from areas outside VA could also be identified, organized, and applied in the VA to examine capabilities for adaptation, as well as outcomes.
In addition to telehealth questions above, how helpful do patients find their patient portal, in reviewing their medical record? Is the information understandable? Is it complete? Does it provide the information that Veterans would like to know? How can the portal be improved? How is the secure messaging function incorporated into clinical workflow and the medical record? How useful is this? What are its effects among specific groups of Veterans?
How does using the EHR affect the quality and safety of medical care? In addition to questions above that pertain to research, how can administrative functions such as quality measurement be automated with clarity and transparency, including linking summary findings to original data sources? Is there support for specific roles such as nurses, pharmacists, and social workers?
EHR modernization is likely to change how Veterans interact with their health institutions and healthcare teams. How are telehealth, e-consultations, and provider-to-provider communication affected, and how can they evolve most effectively? How is the quality of the patient-physician relationship affected by video visits vs. phone vs. face-to-face?
Many EHR users learn to use those systems “in situ”, from other people of various experience levels (novice to expert). How is EHR learning accomplished, and best accomplished? What are the roles of each site's leaders and superusers? Which training methods are most effective and sustainable, considering the periodic turnover of clinical staff and trainees?
What are the responses, attitudes, and challenges experienced by users and implementers? How does EHRM support users, foster patient-centered care, and help to solve problems? What consequences are unexpected?
How does EHRM affect the role of the EHR in assessing and improving the cost and value of medical care?
How have visualization of data, alerts, and medical decision-making, changed with EHR modernization, and what are the outcomes? How are efficiency, safety, and population management affected?
* Considering the EHR modernization (EHRM) that is currently underway, and also certain temporary limitations in the availability of new-EHR data for research as a result of that modernization, the indicated topics have special needs for timely research. Partnering with clinical or operations-based offices is desirable in pursuing many of these areas. Although an important topic, telehealth is excluded here due to the separate work of the VA HSR&D Virtual Care Core.
Outcomes of interest may include measures of any of the following: access to analyzable data, access to care, access to clinically usable data, activities in coordination and communication of care, dissemination and adoption of EHR-related practices, effect of clinical decision support, follow-up of diagnostic testing, medical errors, patient engagement, referrals and consultations, safe prescribing of medications, satisfaction, specific dimensions of quality, system interoperability, time and efficiency, tracking of tasks, turnover of clinicians, and usability.