4049 — Challenges of Transitioning from VA’s Homegrown Electronic Health Record System to a Vendor-based System: Findings from the First Go Live Site

Lead/Presenter: Megan Moldestad,  COIN - Seattle/Denver
All Authors: Moldestad M (Center of Innovation for Veteran-Centered and Value-Driven Care), Brunner J (Center for the Study of Healthcare Innovation, Implementation & Policy) Anderson E (Center for Healthcare Organization and Implementation Research) Rinne S (Center for Healthcare Organization and Implementation Research) Sayre G (Center of Innovation for Veteran-Centered and Value-Driven Care)

Objectives:
Transitions from one electronic health record (EHR) system to another are particularly challenging for organizations moving from EHRs developed in house (i.e., “homegrown”) to vendor-developed systems (Hanauer et al., 2017). Our team evaluated frontline clinician and staff experiences at the first VA EHR transition site to understand site challenges and inform and improve the ongoing VA EHR transition.

Methods:
As one element of a mixed methods evaluation, we interviewed 25 providers, nurses, and other clinical staff across 122 semi-structured interviews and brief check-ins at several points before and after go-live (9/2020 to 11/2021). Transcripts were coded using both inductive and deductive approaches, and content relevant to clinician/staff experiences was extracted and thematically analyzed.

Results:
Prior to go-live, participants expressed cautious optimism about the new EHR system, and appeared to be embracing the impending change. Yet in the weeks and months immediately following go-live, they described multiple challenges related to the experience of transitioning to a vendor-based system, including that vendor-led training and the new EHR itself reflected a lack of familiarity with VA clinical processes, workflows, roles, lingo, and culture. These challenges persisted one year after go-live, and participants perceived a lack of compatibility between the new EHR and VA.

Implications:
VA's transition from a highly tailored, homegrown EHR system to a vendor-based one is not only a technological challenge but a cultural transformation. The EHR transition is causing profound shifts in organizational practices and routines that many perceive as undesirable and fraught with unintended consequences. The perceived lack of fit between the new EHR and VA’s institutional mission is a particular source of misgivings. It is essential to engage users at all levels during the implementation process to ensure the new system reflects a nuanced understanding of organizational routines. Where changes in an organization’s practices are unavoidable to fit the new EHR, it is essential leadership communicates the rationale behind changes clearly and proactively and provides a realistic picture of challenges to come.

Impacts:
This study identifies critical EHR transition challenges from a homegrown system that should be considered against the potential benefits of transitioning to a vendor-developed system. For example, the local and culturally-based fit of homegrown systems should be considered against factors such as economies of scale and standardized workflows and interfaces. These findings can inform health systems undergoing such transitions, and these recommendations can inform change management processes to mitigate negative impacts in the coming years of VA’s EHR transition.