Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 3, 2023
Date Accepted: Jun 26, 2024
Transitioning from a homegrown electronic health record to a vendor-based product: A qualitative evaluation of end-user experiences from VA’s first EHR transition site
ABSTRACT
Background:
The Department of Veterans Affairs (VA), the largest nationally integrated health system in the United States, is transitioning from its homegrown electronic health record (EHR) to a new vendor-based Oracle Cerner EHR. Experiences of the first VA site to transition have been widely discussed in the media, but in-depth accounts based on rigorous research are lacking.
Objective:
We sought to fill this gap by exploring the shifting employee perspectives on the rationale for and value of transitioning from an EHR that was highly tailored to VA’s needs to a vendor-based product that appears to be significantly less so.
Methods:
As part of a larger mixed-methods, multi-site formative evaluation of VA clinician and staff experiences with the EHR transition, we conducted semi-structured interviews at the Mann-Grandstaff VA Medical Center (MGVAMC) before, during, and after “go-live” in October 2020. In total, we completed 122 interviews with 26 participants across multiple departments.
Results:
Prior to the new EHR going-live, participants initially expressed cautious optimism about the transition. However, in subsequent interviews following go-live participants increasingly critiqued the vendor’s understanding of VA’s needs, values, and workflows, as well as what they perceived as an inadequate fit between the functionalities of the new EHR system and VA’s characteristic approach to care. As much as a year after go-live, participants reiterated these concerns, while also expressing a desire for substantive changes to the transition process, with some questioning the value of continuing with the transition.
Conclusions:
VA’s transition from a homegrown EHR to a vendor-based EHR system has presented significant challenges both practical and cultural in nature. As such, it is a valuable case study for understanding the sociotechnical dimension of EHR-to-EHR transitions. These findings have implications for both VA leadership and the broader community of policymakers, vendors, informaticists, and others involved in large-scale health information technology implementations.
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