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

加强卫生专业学员的中心实施，以优化学习并加强退伍军人护理（学者）

• 批准号: 10416608
• 负责人: Seppo T Rinne
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10416608
• 关键词: Address; Attention; Attitude; Behavior; Caring; Case Series; Clinical; Clinical Services; Competence; Consensus; Data; Education; Electronic Health Record; Employee; Ensure; Evaluation; Failure; Funding; Goals; Health; Health Occupations; Health Services Research; Health Transition; Health education; Healthcare Systems; Home; Intervention; Interview; Knowledge; Learning; Letters; Medical; Medical center; Methods; Mission; Modeling; Modernization; Organizational Change; Phase; Play; Problem Solving; Process; Provider; Reaction; Research Methodology; Role; Rotation; Site; Structure; Surveys; Testing; Time; Training; Training Programs; United States; Veterans; Work; acceptability and feasibility; care delivery; care outcomes; career; cost effective; design; experience; graduate medical education; human centered design; improved; negative affect; pilot test; prevent; prototype; therapy design; uptake; willingness

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.

项目背景： VA 组织转型的变革管理工作以取代 现有的电子健康记录 (EHR) 主要侧重于支持 VA 员工，而较少 我们关注卫生专业实习生 (HPT) 的独特需求，他们在 退伍军人护理中心的初步调查结果表明，许多 HPT 都存在问题。 在获取和使用电子病历方面遇到了挑战，这对他们的教育和生活产生了不利影响 迫切需要改进提供退伍军人护理的能力，以确保 HPT 得到快速采用和利用。 使用新的电子病历，同时减轻对教育和退伍军人护理的负面影响。 项目目标：该提案的主要目标是在 VA 的 EHR 期间确定并解决 HPT 的需求 我们将结合卫生服务研究和以人为本的设计（HCD）方法来确定。 HPT 的 EHR 过渡的潜在改进机会 该提案是与合作制定的。 学术联系办公室 (OAA) 和电子健康记录现代化办公室 (OEHRM) 为了实现通过 VA 的 EHR 过渡改善 HPT 体验的共同目标，我们的具体目标是： 目标 1：识别并了解 HPT 的 EHR 过渡挑战和需求。 让 HPT、临床教育工作者和 VA EHR 过渡站点的学术附属机构参与进来，评估 HPT 的 经验，包括及时和适当的 EHR 访问、EHR 过渡态度、EHR 信心、EHR 使用行为、临床教育和退伍军人护理服务。 目标 2：设计原型干预措施以改善 HPT 的 EHR 过渡。 聘请由 OAA、OEHRM、Cerner、学术附属机构和 HPT 组成的专家小组来确定参数 EHR 过渡干预措施，并与目标 1 利益相关者合作设计原型干预措施。 目标 3：评估原型干预的可接受性、可行性以及对 EHR 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站点对 EHR 访问和使用的影响。 项目方法：我们设计了一个多阶段评估来了解 HPT 和 EHR 的过渡 制定干预措施来改善他们的 EHR 体验。我们将使用调查、定性访谈和 EHR 使用数据来了解 EHR 过渡的 HPT 经验（目标 1）。 就改善 HPT 的 EHR 过渡的干预参数达成共识的方法，以及 我们将让 HPT 参与 HCD 方法，以开发干预措施的原型草案（目标 2）。 两个 EHR 过渡站点的原型，并使用调查和访谈来评估干预措施的可接受性 我们还将比较相对于两个控制站点的 EHR 访问和使用（目标 3）。 预期结果：我们将确定可改善 Kirkpatrick 四个级别的 HPT 体验的实践 模型：反应（对 EHR 过渡的态度）、学习（EHR 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服务）。 评估将导致试点测试的干预措施，以优化 HPT 的 EHR 过渡。 结论：该提案直接解决了 VA 的两个主要优先事项：教育 HPT 和实现现代化 它将有助于确定有意义且可行的解决方案，确保 HPT 快速掌握和使用 EHR。 新的电子病历，最大限度地减少对其临床教育和为退伍军人护理做出贡献的能力的负面影响。