Harnessing institutional knowledge: mixed methods evaluation of peer coaching in a multi-site EHR transition

Health systems undertaking electronic health record (EHR) transitions often struggle to prepare and support clinicians in learning and using the new system. We evaluated a national peer coaching program-the National EHRM Supplemental Staffing Unit (NESSU)-designed to support clinicians during the U.S. Department of Veterans Affairs' (VA's) transition to a new EHR. Our goal was to assess NESSU's reach, perceived usefulness, and association with key EHR user outcomes, and to characterize how NESSU achieved its observed impacts.

Using a convergent mixed-methods design, we surveyed EHR users at the most recent VA facility to implement the new EHR. Descriptive statistics summarized program reach and perceived helpfulness. Regression models assessed associations between NESSU participation and 3 outcomes: burnout, EHR-related stress, and EHR confidence. Qualitative data included 62 interviews with users and open-ended survey responses. We used structured coding and thematic analysis to identify themes.

Among 385 respondents, 58.4% reported receiving NESSU support and 83.6% of those rated it as helpful. NESSU participation was associated with lower rates of burnout (29% vs 41%, P = 0.016) but not with differences in EHR confidence or EHR-related stress. Qualitative analysis yielded 4 themes describing how NESSU functioned (filling education gaps, providing responsive support, offering expert guidance, and drawing upon notable interpersonal skills) and one theme describing its overall impact.

Findings demonstrate that peer coaching can address important support needs during EHR transitions.

Scalable, clinician-led peer coaching may represent an essential component of large-scale EHR transitions, supporting both implementation and clinician well-being.