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

项目背景：为退伍军人管理局的组织转型改变管理工作，以取代 现有的电子健康记录(EHR)主要集中在支持退伍军人管理局员工，而较少 已注意到卫生职业实习生(HPT)的独特需求，他们在 提供退伍军人护理。退伍军人事务部最初的EHR过渡地点的初步发现表明，许多HPT 在访问和使用EHR时遇到了挑战，这对他们的教育和他们的 提供退伍军人护理的能力。迫切需要改进努力，以确保HPTs迅速被接受并 使用新的《电子健康记录》，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确定和解决退伍军人管理局在电子病历期间的需求 过渡。我们将结合健康服务研究和以人为中心的设计(HCD)方法来确定 HPTS EHR过渡的潜在改进机会。这项建议是与 学术关系办公室(OAA)和电子健康记录现代化办公室(OEHRM) 以满足他们的共同目标，即通过退伍军人管理局的EHR过渡来改善HPT体验。我们的具体目标是： 目标1：确定和了解HPTS的EHR过渡挑战和需求。 在VA EHR过渡站点邀请HPT、临床教育工作者和学术附属机构评估HPTS 经验，包括及时和适当的电子健康记录访问、电子健康记录过渡态度、电子健康记录信心、电子健康记录 使用行为、临床教育和退伍军人护理服务。 目的2：设计一种原型干预以改善高血压患者的EHR转变。 聘请由OAA、OEHRM、CENER、学术分支机构和HPT组成的专家小组确定以下参数 EHR过渡干预措施，并与Aim 1利益相关方合作设计原型干预措施。 目标3：评估原型干预的可接受性、可行性和对电子健康记录使用的影响。 在两个正在进行EHR过渡的地点对Aim 2原型干预进行试点测试，以确定可接受性 和可行性，并比较其相对于两个控制点对电子病历获取和使用的影响。 项目方法：我们设计了一个多阶段评估，以了解HPTS的EHR过渡和 制定干预措施以改善他们的电子病历体验。我们将使用调查、定性访谈和 电子健康记录使用数据了解HPT在电子健康记录过渡方面的经验(目标1)。我们将使用专家小组 就改善高血压患者EHR过渡的干预措施的参数达成共识的方法，以及 我们将让HPTS参与HCD方法，以制定干预的原型草案(目标2)。然后我们将测试 在两个EHR过渡地点进行原型测试，并使用调查和访谈来评估干预的可接受性 和可行性。我们还将比较与两个控制站点相关的EHR访问和使用情况(目标3)。 预期结果：我们将确定改善柯克帕特里克四个级别的HPT体验的做法 模型：反应(对电子健康记录转变的态度)、学习(电子健康记录知识和信心)、行为 (电子病历能力和使用)和结果(临床教育和退伍军人护理提供)。由此得出的结论 评估将导致经过试点测试的干预措施，以优化HPT的EHR过渡。 结论：这项建议直接涉及退伍军人管理局的两个主要优先事项：教育HPT和使其现代化 啊哈。它将有助于确定有意义和可操作的解决方案，以确保HPT快速采用和使用 新的EHR，并最大限度地减少对他们的临床教育和为退伍军人护理做出贡献的能力的负面影响。

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.