Integrating Rapid Cycle Evaluation to Improve Cerner Implementation

项目背景：VA最近与Cerner公司签订合同， 健康记录（EHR）的转型预计将持续十年，耗资160亿美元。虽然EHR 现代化（EHRM）提供了改善护理系统的机会，这些过渡是复杂的 破坏多个社会技术系统的事业，并挑战依赖EHR的临床医生， 提供病人护理。先前的研究发现，EHR过渡具有深刻的破坏性，并影响一线 临床医生的表现和福祉。Cerner的变革管理计划正在以有限的投入指导EHRM 从前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，以便从前线学习 临床医生，确定支持临床团队进行EHRM的方法，并减轻负面影响。 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的变革管理方法。 Cerner将以一系列的滚动波取代现有的EHR，我们将应用快速循环的原则 评价：在这一分阶段办法中评价并逐步改进EHRM。我们已经与 EHRM办公室（OEHRM）设计一项评估，使临床医生参与EHRM， 临床流程和新的EHR，以及帮助建立对所造成的中断的弹性的设计策略 的EHRM。我们的具体目标是： 目标1：进行形成性评价，以确定支持EHRM的最佳做法。 使用混合方法在EHRM初始站点评估预实施、实施和维持 确定改进EHRM成果的做法。 目标2：就VA可以实施的优化EHRM结果的战略达成共识。 与PROVEN召集的专家小组一起使用共识方法， VA临床团队可以用来增强Cerner的变更管理和改进EHRM的实践。 目标3：设计和试点测试的多成分战略，以改善EHRM的成果。 设计一个多方面的战略，其中包括目标1和2中确定的最佳做法，并使用OEHRM 在评估主要执行成果的同时，还将建立网络对战略进行试点测试。 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） 工作流程评估，以比较当前与新的Cerner工作流程;（2）调查，以评估临床团队的 变化准备，临床经验和EHR熟练程度;（3）访谈，反思和观察， 临床团队成员确定用于支持EHR管理的策略;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 分析并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 目标1中的信息，并就VA可以实施以优化EHRM的策略达成共识 成果。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， 改善EHRM成果的多方面战略。我们将与OEHRM网络合作， 战略，同时评估可行性，可接受性和有效性。 预期结果：来自一线临床医生的信息进行EHRM可以告知最佳实践，以改善 EHRM结果。从这次评估的结果将导致一个案例系列，描述初步EHRM 经验，应用专家建议指导EHRM的实施手册，以及 这是一项多部分战略，将在今后的执行试验中加以检验。 结论：该提案直接解决了VA的首要任务，即实现EHR现代化，并将提供 具体建议，以吸引临床医生和改善EHRM的成果。

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.