Integrating Rapid Cycle Evaluation to Improve Cerner Implementation

Project Background: VA recently contracted with the Cerner Corporation to replace its existing electronic health record (EHR) in a transformation that is expected to last ten years and cost $16 billion.

While EHR modernization (EHRM) offers an opportunity to improve systems of care, these transitions are complex undertakings that disrupt multiple sociotechnical systems and challenge clinicians who rely on the EHR to provide patient care.

Prior studies have found that EHR transitions are deeply disruptive and impact frontline clinicians' performance and well-being. Cerner's change management plan is guiding EHRM, with limited input from frontline VA clinicians.

These EHR change management efforts must be evaluated to learn from frontline clinicians, identify ways to support clinical teams undergoing EHRM, and mitigate negative consequences.

Project Objectives: The primary goal of this proposal is to optimize EHRM outcomes by identifying and promoting practices that clinical teams can employ to complement Cerner's change management approach.

Cerner will replace the existing EHR in a series of rolling waves and we will apply principles of Rapid Cycle Evaluation to evaluate and progressively improve EHRM during this phased approach.

We have partnered with the Office of EHRM (OEHRM) to design an evaluation that will engage clinicians in EHRM, improve fit between clinical processes and the new EHR, and design strategies that help build resiliency to the disruption caused by EHRM. Our specific aims are to: Aim 1: Conduct a formative evaluation to identify best practices that support EHRM.

Evaluate pre-implementation, implementation, and sustainment at initial EHRM sites using mixed methods to identify practices to improve EHRM outcomes. Aim 2: Develop consensus on strategies that VA can implement to optimize EHRM outcomes.

Use consensus methods with an expert panel convened by PROVEN to develop recommendations for practices that VA clinical teams can use to augment Cerner's change management and improve EHRM. Aim 3: Design and pilot test a multicomponent strategy to improve EHRM outcomes.

Design a multicomponent strategy that includes best practices identified in Aims 1 and 2 and use OEHRM networks to pilot test the strategy while assessing key implementation outcomes.

Project Methods: In Aim 1, we will conduct a formative evaluation that uses mixed methods, including (1) workflow evaluation to compare current versus new Cerner workflows; (2) surveys to assess clinical teams' change readiness, clinician experience, and EHR proficiency; (3) interviews, reflections and observations with clinical team members to identify strategies used to support EHRM; and (4) EHR log data to assess EHR proficiency.

We will work with teams to synthesize mixed methods results and conduct current state and gap analyses and develop site specific action plans.

In Aim 2, we will use expert panel methods to interpret information from Aim 1 and develop consensus on strategies that VA can implement to optimize EHRM outcomes.

In Aim 3, we will work with OEHRM to apply information from Aims 1 and 2 to design a multicomponent strategy to improve EHRM outcomes.

We will work with OEHRM networks to pilot test the strategy while assessing feasibility, acceptability, and effectiveness.

Expected results: Information from frontline clinicians undergoing EHRM can inform best practices to improve EHRM outcomes.

Findings from this evaluation will lead to a case series that describes initial EHRM experiences, an implementation playbook that applies expert recommendations to guide EHRM, and a multicomponent strategy that will be tested in future implementation trials.

Conclusions: This proposal directly addresses a top VA priority to modernize the EHR and will provide specific recommendations to engage clinicians and improve EHRM outcomes.