Integrating Rapid Cycle Evaluation to Improve Cerner Implementation

项目背景：弗吉尼亚州最近与Cerner Corporation签订了合同，以更换其现有的电子设备 健康记录(EHR)，这一转变预计将持续十年，耗资160亿美元。而电子病历 现代化(EHRM)提供了改善护理系统的机会，这些转变是复杂的 扰乱多种社会技术系统并挑战依赖电子病历的临床医生的承诺 提供病人护理。先前的研究发现，电子病历的过渡具有极大的破坏性，并对前线产生影响 临床医生的表现和幸福感。CENER的变革管理计划正在指导EHRM，投入有限 来自一线退伍军人管理局的临床医生。必须评估这些eHR变更管理工作，以便向一线学习 临床医生，找出支持临床团队进行EHRM的方法，并减轻负面后果。 项目目标：本提案的主要目标是通过确定和 促进临床团队可以采用的实践，以补充Cerner的变化管理方法。 CENER将在一系列滚动波中取代现有的EHR，我们将应用快速循环原理 在这一阶段性方法中，评估并逐步改进EHRM的评估。我们已经与 EHRM办公室(OEHRM)设计了一项评估，将吸引临床医生参与EHRM，改善 临床流程和新的电子病历，并设计有助于建立对造成的中断的恢复能力的策略 由EHRM提供。我们的具体目标是： 目标1：进行形成性评估，以确定支持企业人力资源管理的最佳做法。 使用混合方法评估初始EHRM站点的实施前、实施和维持情况 确定改善企业人力资源管理成果的做法。 目标2：就退伍军人管理局可以实施的战略达成共识，以优化EHRM成果。 与Proven召集的专家小组一起使用协商一致的方法来制定建议 退伍军人管理局临床团队可以用来加强Cerner的变更管理和改进EHRM的实践。 目标3：设计和试行多组成部分战略，以改善企业人力资源管理成果。 设计包括AIMS 1和AIMS 2中确定的最佳实践的多组件战略，并使用OEHRM 在评估关键执行成果的同时对战略进行试点测试的网络。 项目方法：在目标1中，我们将使用混合方法进行形成性评估，包括(1) 工作流评估，以比较当前的Cerner工作流和新的Cerner工作流；(2)调查，以评估临床团队 变更准备情况、临床医生经验和电子病历熟练程度；(3)访谈、反思和观察 临床团队成员，以确定用于支持EHRM的策略；以及(4)EHR日志数据，以评估EHR 熟练程度。我们将与团队合作，综合混合方法的结果，并进行当前状态和差距 分析和制定现场具体行动计划。在目标2中，我们将使用专家小组方法来解释 来自目标1的信息，并就退伍军人管理局可以实施的战略达成共识，以优化EHRM 结果。在目标3中，我们将与OEHRM合作，应用目标1和目标2中的信息来设计 多组成部分战略，以改善企业人力资源管理成果。我们将与OEHRM网络合作，试行 战略，同时评估可行性、可接受性和有效性。 预期结果：来自接受EHRM的一线临床医生的信息可以为改进最佳实践提供参考 电子人力资源管理成果。这项评估的结果将导致描述最初的EHRM的病例系列 经验，应用专家建议指导EHRM的实施攻略，以及 多组成部分战略，将在未来的实施试验中进行测试。 结论：这项建议直接涉及退伍军人管理局实现电子病历现代化的首要任务，并将提供 对临床医生的参与和改善EHRM结果的具体建议。

Project Background: VA recently contracted with the Cerner Corporation to replace its existing electronic health record (EHR) in a transformation that is expected to last ten years and cost $16 billion. While EHR modernization (EHRM) offers an opportunity to improve systems of care, these transitions are complex undertakings that disrupt multiple sociotechnical systems and challenge clinicians who rely on the EHR to provide patient care. Prior studies have found that EHR transitions are deeply disruptive and impact frontline clinicians' performance and well-being. Cerner's change management plan is guiding EHRM, with limited input from frontline VA clinicians. These EHR change management efforts must be evaluated to learn from frontline clinicians, identify ways to support clinical teams undergoing EHRM, and mitigate negative consequences. Project Objectives: The primary goal of this proposal is to optimize EHRM outcomes by identifying and promoting practices that clinical teams can employ to complement Cerner's change management approach. Cerner will replace the existing EHR in a series of rolling waves and we will apply principles of Rapid Cycle Evaluation to evaluate and progressively improve EHRM during this phased approach. We have partnered with the Office of EHRM (OEHRM) to design an evaluation that will engage clinicians in EHRM, improve fit between clinical processes and the new EHR, and design strategies that help build resiliency to the disruption caused by EHRM. Our specific aims are to: Aim 1: Conduct a formative evaluation to identify best practices that support EHRM. Evaluate pre-implementation, implementation, and sustainment at initial EHRM sites using mixed methods to identify practices to improve EHRM outcomes. Aim 2: Develop consensus on strategies that VA can implement to optimize EHRM outcomes. Use consensus methods with an expert panel convened by PROVEN to develop recommendations for practices that VA clinical teams can use to augment Cerner's change management and improve EHRM. Aim 3: Design and pilot test a multicomponent strategy to improve EHRM outcomes. Design a multicomponent strategy that includes best practices identified in Aims 1 and 2 and use OEHRM networks to pilot test the strategy while assessing key implementation outcomes. Project Methods: In Aim 1, we will conduct a formative evaluation that uses mixed methods, including (1) workflow evaluation to compare current versus new Cerner workflows; (2) surveys to assess clinical teams' change readiness, clinician experience, and EHR proficiency; (3) interviews, reflections and observations with clinical team members to identify strategies used to support EHRM; and (4) EHR log data to assess EHR proficiency. We will work with teams to synthesize mixed methods results and conduct current state and gap analyses and develop site specific action plans. In Aim 2, we will use expert panel methods to interpret information from Aim 1 and develop consensus on strategies that VA can implement to optimize EHRM outcomes. In Aim 3, we will work with OEHRM to apply information from Aims 1 and 2 to design a multicomponent strategy to improve EHRM outcomes. We will work with OEHRM networks to pilot test the strategy while assessing feasibility, acceptability, and effectiveness. Expected results: Information from frontline clinicians undergoing EHRM can inform best practices to improve EHRM outcomes. Findings from this evaluation will lead to a case series that describes initial EHRM experiences, an implementation playbook that applies expert recommendations to guide EHRM, and a multicomponent strategy that will be tested in future implementation trials. Conclusions: This proposal directly addresses a top VA priority to modernize the EHR and will provide specific recommendations to engage clinicians and improve EHRM outcomes.