VA's EHR transition and health professions trainee programs: Findings and impacts of a multistakeholder learning community

Julian Brunner; Ellen A Ahlness; Ekaterina Anderson; Brianne K Molloy-Paolillo; Alexandre Braga; Sarah L Cutrona; Christian D Helfrich; Deborah Levy; Erin Matteau; Edward Walton; George Sayre; Seppo T Rinne

doi:10.1002/lrh2.10460

VA's EHR transition and health professions trainee programs: Findings and impacts of a multistakeholder learning community

Learn Health Syst. 2024 Oct 23;9(2):e10460. doi: 10.1002/lrh2.10460. eCollection 2025 Apr.

Authors

Julian Brunner¹, Ellen A Ahlness², Ekaterina Anderson^{3

4}, Brianne K Molloy-Paolillo³, Alexandre Braga³, Sarah L Cutrona^{3

4}, Christian D Helfrich^{5

6}, Deborah Levy^{7

8}, Erin Matteau⁹, Edward Walton⁹, George Sayre^{2

10}, Seppo T Rinne^{3

11}

Affiliations

¹ Center for the Study of Healthcare Innovation Implementation & Policy, VA Greater Los Angeles Health Care Los Angeles California USA.
² Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Medical Center Seattle Washington USA.
³ Center for Healthcare Organization and Implementation Research VA Bedford Healthcare System Bedford Massachusetts USA.
⁴ Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical School Worcester Massachusetts USA.
⁵ Seattle-Denver Center of Innovation VA Puget Sound Health Care System Seattle Washington USA.
⁶ Health Systems and Population Health School of Public Health, University of Washington Seattle WA USA.
⁷ Center of Innovation for Pain Research, Informatics, Multimorbidities, and Education (PRIME) VA Connecticut Health Care West Haven Connecticut USA.
⁸ Yale University School of Medicine New Haven Connecticut USA.
⁹ VA Office of Academic Affiliations Washington DC USA.
¹⁰ University of Washington School of Public Health Seattle Washington USA.
¹¹ Division of Pulmonary and Critical Care Medicine Chobanian and Avedisian School of Medicine, Boston University Boston Massachusetts USA.

Abstract

Introduction: The Department of Veterans Affairs (VA) is undergoing an unprecedented electronic health record (EHR) transition, switching from its homegrown EHR to a commercial system. The transition affects nearly every clinical employee but is particularly disruptive to health professions trainees (HPTs)-an often-overlooked population in EHR transitions. To better understand and address trainee challenges with the EHR transition, we formed a multistakeholder learning community. In this study, we describe the findings of this learning community and the practices and policies developed in response.

Methods: In the qualitative study designed and executed by our learning community, we conducted 51 interviews with HPTs, program leaders, and preceptors before and multiple times after an EHR transition site's go-live (February 16, 2022 to April 7, 2023). We merged interview transcripts with 125 survey free-text responses from a survey conducted with preceptors 2 months post-go-live and conducted thematic analysis to identify key themes. To complement qualitative findings, we also include a quantitative survey finding, and, where applicable, we note policy and practice responses spurred by our learning community.

Results: Interviews yielded six key themes: (1) High satisfaction with HPT programs, despite negative impacts of the EHR transition; (2) early delays, then substantial improvements, in HPTs' EHR access; (3) persistent challenges with HPTs' EHR training and support, mitigated by local and national efforts; (4) the challenge of learning to use a rapidly evolving EHR during clinical training; (5) reduced visit volume as a continuing barrier to education; and (6) an impression that HPTs' relative lack of exposure to the prior EHR facilitated their proficiency with the new EHR.

Conclusions: Findings highlighted challenges for HPT programs related to the EHR transition, which spurred important changes including the creation of a national VA council to represent the needs of HPTs in the EHR transition, and improvements to HPTs' EHR training and access.

Keywords: United States Department of Veterans Affairs; electronic health record implementation; learning health system; medical education; partnered evaluation; qualitative methods.