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

加强卫生专业学员的中心实施，以优化学习并加强退伍军人护理（学者）

• 批准号: 10416608
• 负责人: Seppo T Rinne
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10416608
• 关键词: Address; Attention; Attitude; Behavior; Caring; Case Series; Clinical; Clinical Services; Competence; Consensus; Data; Education; Electronic Health Record; Employee; Ensure; Evaluation; Failure; Funding; Goals; Health; Health Occupations; Health Services Research; Health Transition; Health education; Healthcare Systems; Home; Intervention; Interview; Knowledge; Learning; Letters; Medical; Medical center; Methods; Mission; Modeling; Modernization; Organizational Change; Phase; Play; Problem Solving; Process; Provider; Reaction; Research Methodology; Role; Rotation; Site; Structure; Surveys; Testing; Time; Training; Training Programs; United States; Veterans; Work; acceptability and feasibility; care delivery; care outcomes; career; cost effective; design; experience; graduate medical education; human centered design; improved; negative affect; pilot test; prevent; prototype; therapy design; uptake; willingness

Project Background: Change management efforts for VA’s organizational transformation to replace the existing electronic health record (EHR) have primarily focused on supporting VA employees, while less attention has been given to the unique needs of health professions trainees (HPTs), who play a critical role in delivering Veteran care. Preliminary findings from VA’s initial EHR transition site indicate that many HPTs experienced challenges accessing and using the EHR, which adversely impacted their education and their ability to deliver Veteran care. Improvement efforts are urgently needed to ensure HPTs have rapid uptake and use of the new EHR while mitigating negative impacts on education and Veteran care. Project Objectives: The main goal of this proposal is to identify and address HPTs’ needs during VA’s EHR transition. We will combine health services research and human-centered design (HCD) methods to identify potential improvement opportunities for HPTs’ EHR transition. This proposal was developed in partnership with the Office of Academic Affiliations (OAA) and the Office of Electronic Health Record Modernization (OEHRM) to address their shared goal of improving HPT experience with VA’s EHR transition. Our specific aims are to: Aim 1: Identify and understand HPTs’ EHR transition challenges and needs. Engage HPTs, clinical educators, and academic affiliates at VA EHR transition sites to evaluate HPTs’ experiences, including timely and appropriate EHR access, EHR transition attitudes, EHR confidence, EHR use behaviors, clinical education, and Veteran care delivery. Aim 2: Design a prototype intervention to improve EHR transitions for HPTs. Engage an expert panel of OAA, OEHRM, Cerner, academic affiliates, and HPTs to identify parameters for an EHR transition intervention and work with Aim 1 stakeholders to design a prototype intervention. Aim 3: Assess prototype intervention acceptability, feasibility, and impact on EHR use. Pilot test the Aim 2 prototype intervention at two sites undergoing EHR transitions to establish acceptability and feasibility, and compare its impact on EHR access and use relative to two control sites. Project Methods: We have designed a multi-phased evaluation to understand EHR transition for HPTs and develop an intervention to improve their EHR experiences. We will use surveys, qualitative interviews, and EHR use data to understand HPT experiences with the EHR transition (Aim 1). We will use expert panel methods to develop consensus on parameters for an intervention to improve the EHR transition for HPTs, and we will engage HPTs in HCD methods to develop a draft prototype of the intervention (Aim 2). We will then test the prototype at two EHR transition sites and use surveys and interviews to assess intervention acceptability and feasibility. We will also compare EHR access and use relative to two control sites (Aim 3). Expected results: We will identify practices that improve HPT experience across four levels of the Kirkpatrick Model: Reaction (attitudes about the EHR transition), Learning (EHR knowledge and confidence), Behavior (EHR competence and use), and Results (clinical education and Veteran care delivery). Findings from this evaluation will lead to a pilot-tested intervention to optimize EHR transitions for HPTs. Conclusions: This proposal directly addresses two major VA priorities: educating HPTs and modern izing the EHR. It will help identify meaningful and actionable solutions that can ensure HPTs rapid uptake and use of the new EHR and minimize negative impacts on their clinical education and ability to contribute to Veteran care.

项目背景：VA组织转型的变更管理工作，以取代 现有的电子健康记录（EHR）主要侧重于支持VA员工，而 卫生专业培训生（HPT）的独特需求得到了关注，他们在以下方面发挥着关键作用： 提供退伍军人护理。从VA最初的EHR过渡网站的初步调查结果表明，许多HPT 在获取和使用电子健康记录方面遇到了挑战，这对他们的教育和 提供退伍军人护理的能力。迫切需要做出改进努力，以确保HPT得到快速吸收， 使用新的EHR，同时减轻对教育和退伍军人护理的负面影响。 项目目标：本提案的主要目标是在VA的EHR期间确定和解决HPT的需求 过渡我们将结合联合收割机卫生服务研究和以人为本的设计（HCD）方法， HPT的EHR过渡的潜在改进机会。该提案是与以下机构合作制定的： 学术联盟办公室（OAA）和电子健康记录现代化办公室（OEHRM） 以实现他们的共同目标，即通过VA的EHR过渡改善HPT体验。我们的具体目标是： 目标1：识别和理解HPT的EHR过渡挑战和需求。 让HPT、临床教育工作者和VA EHR过渡站点的学术分支机构参与评估HPT的 经验，包括及时和适当的EHR访问，EHR过渡态度，EHR信心，EHR 使用行为、临床教育和退伍军人护理服务。 目标2：设计一个原型干预，以改善HPT的EHR过渡。 让OAA、OEHRM、Cerner、学术分支机构和HPT组成的专家小组参与， EHR过渡干预措施，并与目标1利益相关者合作设计干预措施原型。 目标3：评估原型干预的可接受性，可行性和对EHR使用的影响。 在两个正在进行EHR过渡的站点对Aim 2原型干预进行试点测试，以确定可接受性 和可行性，并比较其对EHR访问和使用相对于两个控制站点的影响。 项目方法：我们设计了一个多阶段的评估，以了解HPT的EHR过渡， 制定干预措施，以改善他们的EHR体验。我们将使用调查，定性访谈， EHR使用数据来了解HPT在EHR过渡中的经验（目标1）。我们将使用专家小组 就干预参数达成共识的方法，以改善HPT的EHR过渡，以及 我们将让HPT参与HCD方法，以开发干预的原型草案（目标2）。然后我们将测试 原型在两个EHR过渡站点，并使用调查和访谈来评估干预的可接受性 和可行性我们还将比较EHR访问和使用相对于两个控制站点（目标3）。 预期结果：我们将确定在柯克帕特里克的四个级别上改进HPT体验的实践 模型：反应（对EHR过渡的态度），学习（EHR知识和信心），行为 (EHR能力和使用）和结果（临床教育和退伍军人护理服务）。时发现的问题 评估将导致试点测试的干预措施，以优化HPT的EHR过渡。 结论：这项建议直接解决了两个主要的VA优先事项：教育HPT和现代化 电子病历它将有助于确定有意义和可操作的解决方案，以确保HPT快速吸收和使用 新的电子健康记录，并尽量减少对他们的临床教育和能力，促进退伍军人护理的负面影响。