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

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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.