Super Users' Reported Best Practices for Coordinating Proactive Integrated Use of Virtual Health Care Resources:...

Proactive integrated virtual health care resource (VHR) use is the self-initiated, coordinated use of applicable virtual systems as a team or an individual for coordinating timely delivery of high-quality health care. Based on literature and the purpose of this project, super users are defined as clinical team members identified by colleagues as proactive users of VHRs (ie, early adopters) who coordinate care delivery and champion resource use. Super users' proactive integrated VHR use improves workflow and workload efficiency and supports provider uptake and promotion, which increases patient adoption and sustained use to improve care outcomes. Previous studies have not examined super users' integrated use of available VHRs across the health care continuum or within service-specific clinical workflows.

The objective of this project was to describe VHR super users' activities and outcomes to document their practices and inform identification and dissemination of current and best practices.

A prospective, concurrent, mixed methods design using qualitative interviewing and human-centered design was applied. Purposive sampling was used to recruit and conduct interviews with super users across 5 specialty services (ie, cardiology, whole health, spinal cord injury, education, and rehabilitation) at a large Department of Veterans Affairs hospital in the Southeastern United States. Tailored scripts and surveys were used to conduct data collection. Rapid iterative content analysis and data triangulation were used to inform data distillation.

Super user (N=15) data, from specialty services (n=5) revealed 57 best practices (48 data-derived and 9 established) using 60 VHRs within 11 major categories of tasks (eg, appointment management, patient care delivery, medication management), with 43 subcategories (eg, scheduling, appointment reminder, preappointment huddles). Computerized patient record system and joint legacy viewer, Secure Messaging, telephone, Department of Veterans Affairs Video Connect, and Microsoft Teams were reported as 5 most commonly used VHRs. Across the care continuum, best practices around patient-generated health data (n=15), and appointment management and patient and staff technology resource access (n=13) were most commonly reported.

Results identify super users' practices through case scenarios that illustrate the integration of VHRs within and across service-specific clinical workflows. This project informs "best practices" through integrated use of VHRs across the care continuum. While the findings were specific to 5 specialty services, practices can be applied across services throughout workflows. Recommendations were also made for consideration for deimplementation of select practices. Findings can be used for training, education, and establishing best practices and deimplementation of practices. Future research should aim to evaluate outcomes associated with the use of best practices. These data-driven products lay foundational work in identifying and disseminating best practices in VHR use to inform the transformation of the Veterans Health Administration's learning health care system into a culture of VHR super users.