"Everything's so Role-Specific": VA Employee Perspectives' on Electronic Health Record (EHR) Transition Implications...

Area of Science:

• Health Informatics
• Organizational Change Management
• Clinical Workflow Analysis

Background:

• Electronic health record (EHR) transitions are common and disruptive.
• The Veterans Affairs (VA) is transitioning from its homegrown EHR (CPRS/Vista) to Cerner.
• This transition offers insights into large-scale EHR-to-EHR challenges.

Purpose of the Study:

• To examine the organizational impact of the VA's EHR transition.
• To investigate implications for employee roles and responsibilities.
• Focus on the first VA site to implement Cerner Millennium EHR.

Main Methods:

• Conducted 111 interviews with 26 clinicians and staff at Mann-Grandstaff VA Medical Center.
• Interviews occurred before, during, and after the EHR transition (July 2020-November 2021).
• Utilized qualitative content analysis of semi-structured interviews.

Main Results:

• Cerner's role-based access restricted functionality compared to the previous EHR.
• Participants reported a mismatch between institutional duties and EHR permissions.
• Unanticipated changes in duties and communication/collaboration impediments due to role-based views were observed.

Conclusions:

• EHR role settings must align with existing workflows to prevent errors and dissatisfaction.
• Proactive planning, communication, and monitoring are crucial for mitigating risks.
• Accurate role configuration by vendors is essential for smooth transitions.