Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

doi:10.1007/s11606-023-08289-y

. 2023 Oct;38(Suppl 4):965-973.

doi: 10.1007/s11606-023-08289-y. Epub 2023 Oct 5.

Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

Alison M Cogan^{1

2}, Seppo T Rinne^{3

4}, Michael Weiner^{5

6

7}, Steven Simon^{8

9}, Jessica Davila^{10

11}, Elizabeth M Yano^{8

9

12}

Affiliations

¹ Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA. alison.cogan@chan.usc.edu.
² VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. alison.cogan@chan.usc.edu.
³ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
⁴ Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁵ Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
⁶ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁷ Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁸ VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁹ Department of Medicine, University of California, Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA.
¹⁰ Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
¹¹ Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
¹² Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.

PMID: 37798575
PMCID: PMC10593706
DOI: 10.1007/s11606-023-08289-y

Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

Alison M Cogan et al. J Gen Intern Med. 2023 Oct.

. 2023 Oct;38(Suppl 4):965-973.

doi: 10.1007/s11606-023-08289-y. Epub 2023 Oct 5.

Authors

Alison M Cogan^{1

2}, Seppo T Rinne^{3

4}, Michael Weiner^{5

6

7}, Steven Simon^{8

9}, Jessica Davila^{10

11}, Elizabeth M Yano^{8

9

12}

Affiliations

¹ Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA. alison.cogan@chan.usc.edu.
² VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. alison.cogan@chan.usc.edu.
³ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
⁴ Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
⁵ Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
⁶ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁷ Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁸ VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁹ Department of Medicine, University of California, Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, CA, USA.
¹⁰ Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
¹¹ Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
¹² Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.

PMID: 37798575
PMCID: PMC10593706
DOI: 10.1007/s11606-023-08289-y

Abstract

Background: The U.S. Department of Veterans Affairs (VA) is undergoing an enterprise-wide transition from a homegrown electronic health record (EHR) system to a commercial off-the-shelf product. Because of the far-reaching effects of the EHR transformation through all aspects of the healthcare system, VA Health Services Research and Development identified a need to develop a research agenda that aligned with health system priorities so that work may inform evidence-based improvements in implementation processes and outcomes.

Objective: The purpose of this paper is to report on the development of a research agenda designed to optimize the EHR transition processes and implementation outcomes in a large, national integrated delivery system.

Design: We used a sequential mixed-methods approach (portfolio assessment, literature review) combined with multi-level stakeholder engagement approach that included research, informatics, and healthcare operations experts in EHR transitions in and outside the VA. Data from each stage were integrated iteratively to identify and prioritize key research areas within and across all stakeholder groups.

Participants: VA informatics researchers, regional VA health system leaders, national VA program office leaders, and external informatics experts with EHR transition experience.

Key results: Through three rounds of stakeholder engagement, priority research topics were identified that focused on operations, user experience, patient safety, clinical outcomes, value realization, and informatics innovations.

Conclusions: The resulting EHR-focused research agenda was designed to guide development and conduct of rigorous research evidence aimed at providing actionable results to address the needs of operations partners, clinicians, clinical staff, patients, and other stakeholders. Continued investment in research and evaluation from both research and operations divisions of VA will be critical to executing the research agenda, ensuring its salience and value to the health system and its end users, and ultimately realizing the promise of this EHR transition.

Keywords: United States Department of Veterans Affairs; Veterans health services; electronic health records; informatics.

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Conflict of interest statement

The authors do not have conflicts of interest to report.

Figures

**Fig. 1**
Overview of steps to developing the VA electronic health record (EHR) research agenda. Abbreviations: EHR, electronic health record; EHRM, electronic health record modernization; HSR&D, Health Services Research and Development; OEHRM, Office of Electronic Health Record Modernization; PROVEN, Coordinating Hub to Promote Research Optimizing Veteran-centric EHR Research Networks; VA, Department of Veterans Affairs; VIReC, VA Information Resource Center.

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References

1. Adirim T. VA's Electronic Health Record Modernization: Innovating and strengthening with each new deployment. The Spokesman-Review. 2022/06/08/. https://www.spokesman.com/stories/2022/jun/08/vas-electronic-health-reco.... Accessed 9 June 2022
1. Atherton J. Development of the Electronic Health Record. Virtual Mentor. 2011;13(3):186–189. doi: 10.1001/virtualmentor.2011.13.3.mhst1-1103. - DOI - PubMed
1. U.S. Department of Veterans Affairs. History of IT at VA. Digital VA. Published May 23, 2022. Accessed 18 November 2022. https://www.oit.va.gov/about/history.cfm
1. Brown SH, Lincoln MJ, Groen PJ, Kolodner RM. VistA-U.S. Department of Veterans Affairs national-scale HIS. Int J Med Inform. 2003;69:135–156. doi: 10.1016/S1386-5056(02)00131-4. - DOI - PubMed
1. Price LE, Shea K, Gephart S. The Veterans Affairs's Corporate Data Warehouse. Nurs Adm Q. 2015;39(4):311–318. doi: 10.1097/NAQ.0000000000000118. - DOI - PMC - PubMed

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[1] Adirim T. VA's Electronic Health Record Modernization: Innovating and strengthening with each new deployment. The Spokesman-Review. 2022/06/08/. https://www.spokesman.com/stories/2022/jun/08/vas-electronic-health-reco.... Accessed 9 June 2022

[2] Adirim T. VA's Electronic Health Record Modernization: Innovating and strengthening with each new deployment. The Spokesman-Review. 2022/06/08/. https://www.spokesman.com/stories/2022/jun/08/vas-electronic-health-reco.... Accessed 9 June 2022

[3] Atherton J. Development of the Electronic Health Record. Virtual Mentor. 2011;13(3):186–189. doi: 10.1001/virtualmentor.2011.13.3.mhst1-1103. - DOI - PubMed

[4] Atherton J. Development of the Electronic Health Record. Virtual Mentor. 2011;13(3):186–189. doi: 10.1001/virtualmentor.2011.13.3.mhst1-1103. - DOI - PubMed

[5] U.S. Department of Veterans Affairs. History of IT at VA. Digital VA. Published May 23, 2022. Accessed 18 November 2022. https://www.oit.va.gov/about/history.cfm

[6] U.S. Department of Veterans Affairs. History of IT at VA. Digital VA. Published May 23, 2022. Accessed 18 November 2022. https://www.oit.va.gov/about/history.cfm

[7] Brown SH, Lincoln MJ, Groen PJ, Kolodner RM. VistA-U.S. Department of Veterans Affairs national-scale HIS. Int J Med Inform. 2003;69:135–156. doi: 10.1016/S1386-5056(02)00131-4. - DOI - PubMed

[8] Brown SH, Lincoln MJ, Groen PJ, Kolodner RM. VistA-U.S. Department of Veterans Affairs national-scale HIS. Int J Med Inform. 2003;69:135–156. doi: 10.1016/S1386-5056(02)00131-4. - DOI - PubMed

[9] Price LE, Shea K, Gephart S. The Veterans Affairs's Corporate Data Warehouse. Nurs Adm Q. 2015;39(4):311–318. doi: 10.1097/NAQ.0000000000000118. - DOI - PMC - PubMed

[10] Price LE, Shea K, Gephart S. The Veterans Affairs's Corporate Data Warehouse. Nurs Adm Q. 2015;39(4):311–318. doi: 10.1097/NAQ.0000000000000118. - DOI - PMC - PubMed

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Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

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Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

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