Optimizing Employee Well-being and Retention during Electronic Health Record Modernization

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Background: VA’s ongoing electronic health record modernization (EHRM) represents one of the largest and complex organizational initiatives VA has undertaken. VA leadership recognizes the ability to consistently provide high quality care depends on a fully staffed and highly effective workforce. VA’s current EHRM initiative, if poorly implemented, is a major threat to this operational need. Early work indicates that EHRM at the first site to undergo transition (i.e., go-live) was profoundly disruptive to clinicians, adversely impacting perceptions of the EHR, employee morale and the ability to deliver clinical care. VA operational leaders are in urgent need of information to alter the course of EHRM to ensure the well-being of a fully staffed and high functioning health workforce. Significance: The proposed study will generate timely data-driven insights to enable operational and facility leaders to enact fast-paced decisions and strategies designed to mitigate undesirable workforce outcomes resulting from EHRM including turnover, absenteeism, burnout. Findings will also inform the strategic delivery of workplace intervention by identifying VA clinician subgroups at highest risk of adverse workforce outcomes. EHRM is expected to continue for several years, and study findings will provide actionable insights to support change readiness and improve EHRM processes at facilities awaiting go-live. Innovation and Impact: The key innovation of the study is the generation of new scientific knowledge that comprehensively identifies how EHRM affects four workforce outcomes: turnover, absenteeism, burnout, and engagement. New insights gained from this study will provide timely insights to meaningfully improve the course of EHRM in VA and guide other non-VA health systems planning their own EHRM. Specific Aims: Project specific aims include: 1) examine the association between EHRM implementation and workforce outcomes using econometric methods, 2) explore key EHRM related themes associated with workforce outcomes using longitudinal qualitative methods and 3) design and administer a survey to identify key EHRM factors associated with workforce outcomes. Methodology: This multi-methods study will examine the effects of EHRM across VA nationally. Data sources will include employee information from the VA Corporate Data Warehouse, Personnel and Accounting Integrated Data files, HR SMART database, the VA All Employee Survey, and semi-structured interviews. In Aim 1, a quasi-experimental study design will be applied to quantitatively identify overall and subgroup effects of EHRM by leveraging pseudo-random variation in the staggered implementation of EHRM. In Aim 2, we will collect and analyze qualitative data from key informant interviews to explore EHRM-related elements associated with workforce outcomes. Data will be collected from remaining and separated clinicians at sites expected to go-live in the proceeding months. Aim 3 will apply multivariable regression techniques to examine relationships between perceptions of EHRM elements and workforce outcomes using new survey data collected in this study. Implementation/Next Steps: Study findings will be used to inform the design and modification of tools to effectively implement the new EHR and/or promote positive workforce outcomes. This includes a new strategic playbook of bottom-up approaches to improve EHRM, to be developed in collaboration with a panel of VA stakeholders. Product development will capitalize on strong working relationships with operational partners developed in prior research including leaders of the Office of the Functional Champion.