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"The mission of EHRM has always been to create a platform that seamlessly delivers the best access and outcomes for our Vets and the best experience for our providers," said VA Secretary Denis McDonough at a recent hearing before the Senate Committee on Veterans Affairs (HealthcareITNews).
VA has contracted with the Cerner Corporation to replace its existing electronic health record (EHR) in a nationwide rolling-wave process that is expected to last 10 years and cost $16 billion. In October 2020, Cerner announced the first successful deployment of the modernized EHR at the Mann-Grandstaff VA Medical Center in Spokane, WA. With this, VA now joins the Department of Defense and the Department of Homeland Security, via the U.S. Coast Guard, in the use of Cerner-powered technology that will create a single health record for 18 million Service members and Veterans, including their family members. Led by Seppo Rinne, MD, PhD, in Bedford, MA, and George Sayre, PsyD, in Seattle, WA, EHRM Partnership Integrating Rapid Cycle Evaluation to Improve Cerner Implementation (EMPIRIC) QUERI aims to improve VA’s electronic health record modernization (EHRM) by ensuring that it is informed by frontline clinician and staff experiences.
While EHRM offers an opportunity to improve systems of care, EHR transitions are complex undertakings that disrupt multiple socio-technical systems and impact clinician and staff performance and wellbeing. VA must evaluate EHRM change management efforts to identify ways to support clinical teams undergoing EHRM – and mitigate potential risks to care quality and safety. Learning from frontline clinicians and staff is essential in making the EMPIRIC evaluation a success.
It’s hard to describe how [Cerner Implementation] impacts your work so profoundly – and makes you so inefficient and feel really limited…. It makes you feel like you cut your hand off, and you can’t do the job in a safe, effective, productive way. –non-VA clinician
The primary goal of EMPIRIC QUERI is to identify challenges and best practices to support clinicians and inform the nationwide Cerner EHR rollout. By identifying and working with VA national EHRM leadership to promote practices that VA clinical teams can use to complement existing change management efforts, EMPIRIC will optimize outcomes across successive EHRM waves. This will be done by:
- Conducting formative mixed-methods evaluations at initial EHRM sites to identify lessons that can improve EHRM outcomes.
- Developing a case series of process changes and practices from initial EHRM experiences.
- Developing consensus on strategies that VA can implement to optimize EHRM outcomes.
- Generating a playbook of best practices for optimal EHRM.
- Designing and pilot testing a multicomponent strategy to improve EHRM outcomes.
- Testing a multicomponent strategy to optimize EHRM across consecutive implementation trials.
VA’s EHR modernization represents an unprecedented organizational change. Our evaluation efforts can ensure that this change is informed by data and continuously improves from one wave to the next. –Dr. Seppo Rinne
Engaging Initial Cerner Implementation Sites
EMPIRIC is engaged with local leadership and clinicians at VA healthcare systems currently implementing Cerner and is conducting: workflow analyses, surveys, interviews and brief check-ins, and EHR use data analysis. Next steps include consensus recommendations, as well as observations.
A key role of QUERI partnered evaluations is to engage with VA providers and frontline staff to ensure that their voices are heard by policymakers, so that their experience can inform and impact critical organizational changes. –Dr. George Sayre
EMPIRIC is a multidisciplinary team partnered with VA’s Office of Electronic Health Record Modernization (OEHRM) Change Management and local VA sites that will address top VA priorities and produce actionable recommendations to improve EHRM.