“Everything’s so Role-Specific”: VA Employee Perspectives’ on Electronic Health Record (EHR) Transition Implications for Roles and Responsibilities

• DOI: 10.1007/s11606-023-08282-5
• Publication Date: 2023-10-05T18:02:27Z
• Authors: Ellen A. Ahlness; Jay Orlander; Julian Brunner; Sarah L. Cutrona; Bo Kim; Brianne K. Molloy...; Seppo T. Rinne; Justin Rucci; George Sayre; Ekaterina Anderson
• Keywords: Snowball sampling; Veterans Affairs; Electronic health record

Abstract Background Electronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate mitigate such disruptions. Veterans Affairs (VA) undergoing a large-scale transition its homegrown EHR (CPRS/Vista) commercial (Cerner), creating unique opportunity of shedding light on EHR-to-EHR challenges. Objective To explore one facet the organizational impact VA’s transition: implications for employees’ roles responsibilities at first VA site implement Cerner Millennium EHR. Design As part formative evaluation frontline staff with transition, conducted brief (~ 15 min) full-length interviews 60 clinicians Mann-Grandstaff Medical Center in Spokane, WA, before, during, after (July 2020-November 2021). Participants We 111 26 Spokane staff, recruited via snowball sampling. Approach audio using semi-structured guide grounded prompts. coded interview transcripts priori emergent codes, followed by qualitative content analysis. Key Results Unlike previous EHR, imposes additional restrictions access functionality based upon “roles” assigned users. described mismatch between established institutional duties their permissions, unanticipated changes scope brought as well impediments communication collaboration due different role-based views. Conclusions Health systems should substantive impacts professional workflows when role settings do not reflect prior workflows. Such may increase user error, dissatisfaction, patient care employee dissatisfaction safety risks, proactively plan communicate about expected modifications monitor unintended role-related consequences transitions, while vendors ensure accurate configuration assignment.