1. Summarize the importance of HPTs in the VA healthcare workforce.
2. Identify the unique challenges HPTs faced in learning and using the new Federal electronic health record (EHR) during the Columbus and Lovell VAMC EHR transitions.
3. Interpret the outcomes of change management efforts on HPT experiences during Lovell FHCC’s EHR transition.
4. Understand the application of the learning health systems framework within the context of the VA’s nationwide EHR transition.
Objective: To identify and understand successful change management improvements resulting from an operational partnership evaluation on Health Professions Trainee (HPT) experiences during Veterans Health Administration’s (VA’s) nationwide electronic health record (EHR) transition. EHR transitions are known to be highly disruptive events that negatively impact heath system workforces. This subsequently can negatively impact patient care. VA is undergoing a nationwide transition from its homegrown EHR (VistA/CPRS) to a new, commercial Federal EHR. This process, while currently on pause, was last projected to take 10+ years and cost over $51 billion. HPTs play a critical role in providing effective and safe care, yet compared to VA’s employee workforce, they face unique challenges and experience unique needs in learning and using the new federal EHR. VA must understand and mitigate negative EHR transition impacts on HPTs to continue to provide quality care to its Veterans. Design: The Strengthening Cerner Implementation for Health Professions Trainees to Optimize Learning and Reinforce Veteran Care SCHOLAR Evaluation Team and VA’s Office of Academic Affiliations (OAA) formed an operational partnership to collect qualitative and quantitative data on real-time user experiences at early VA medical centers (VAMCs) transitioning to the Federal EHR. Data informed the process improvement efforts of OAA and site leaders . For example, OAA applied the lessons learned from Columbus VAMC to a subsequent transition site, Lovell FHCC. Qualitative and quantitative data were then collected at Lovell FHCC to evaluate improvements in user experience. Population: At Columbus VAMC, we conducted grounded interviews and check-ins with HPTs, supervisors, and site leaders 1 month before (n=10), 2-6 weeks after (n=9), 2 months after (n=6), and 10 months after (n=8) its transition date. We fielded HPT surveys 1 month before (n=13), 2 months after (n=10), and 10 months after (n=13) the transition date. At Lovell FHCC, we conducted grounded interviews and check-ins with HPTs, supervisors, and site leaders 1 month before (n=18), 2-6 weeks after (n=20), and 2 months after (n=9) its transition date. We fielded HPT surveys 1 month before (n=36), and 2 months after (n=29) its transition date. Key Findings: Four key challenges were identified at Columbus VAMC: 1) HPTs experienced significant delays in gaining access to the new EHR; 2) HPTs experienced lengthy (20+ hours) EHR training requirements, 3) EHR training was critiqued for being not relevant to HPT needs, and 4) HPT expressed that the EHR transition negatively impacted their desire to work for VA in the future. These challenges became the focus for OAA’s change management efforts at Lovell. OAA developed guidelines for provisioning HPTs in the new EHR before their start dates, enabled sites to send in provisioning sheets before final numbers of HPTs were identified, reduced training course requirements, and championed the use of at-the-elbow support for transitioning users. Subsequent evaluation at Lovell FHCC found 1) far fewer HPTs experienced delays in gaining access to the new EHR, 2) HPT EHR training took ~8 hours to complete, 3) HPTs benefitted from non-formal service-line-specific EHR instruction, and 4) HPTs felt the EHR transition impacted their clinical training but did not meaningfully affect their career plans. Conclusions: The SCHOLAR/OAA operational partnership enabled both parties to leverage and benefit from a learning health systems framework, wherein collected data informs the body of knowledge from which change management improvements are made. HPTs at Lovell detailed transition experiences that were meaningfully better than those described by Columbus HPTs. The resulting improvements in HPT transition experiences allowed evaluators to focus on other HPT experience pressure points. Policy Implications: Effective operational partnerships have the capacity to produce real mitigation of the negative effects of EHR transitions. Subsequent VAMCs to transition to the new Federal EHR will benefit from change management that is enabled to act quickly and responsively to emergent discoveries in user experience.