Research & EHR Synergy Cyberseminar Series

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Research & EHR SynergyCyberseminar Series

PROVEN Coordinating Hub toAccelerate Electronic Health RecordModernization ResearchSteven Simon, MD, MPH (Los Angeles)Michael Weiner, MD, MPH (Indianapolis)Jessica Davila, PhD (Houston)Elizabeth Yano, PhD (Los Angeles)National VA HSR&D CyberseminarSeptember 1, 2020

Session Objectives What is PROVEN? How does it fit into the Research & EHRMecosystem? Initial pilot projects studying the EHRM What can PROVEN do for you?

PROVEN Coordinating HubADMINISTRATIVE CORESteven Simon, MD, MPHVA Greater Los Angeles

PROVEN Aims & Functions1. SUPPORT. Support, promote, & enhance health services research andrelated to EHRM2. PILOT. Oversee conduct of five rapid pilot projects studying aspects ofthe EHR implementation3. TRAIN and ADVISE. Provide methodological training, methodologicaland informatics expertise, & support to investigators of EHRM4. CONNECT and COORDINATE. Serve as liaison between EHRMresearchers and VA operational partners and implementation sites5. DISSEMINATE. Communicate EHRM research findings to OEHRM andother VA decision-makers, and the informatics research community6. PRIORITIZE. Curate and prioritize the EHRM research agenda

Organizational Chart (Aug 2020)VHA Program OfficesConnected CareCommunity CareVeterans Access to CareNursing ServicesDiscovery, Education & AffiliateNetworks (DEAN)Primary Care Analytics TeamHealth EquityNational Surgery OfficeWomen’s Health Services(others added as appropriate)ExternalPanel ofExpertsOffice of ElectronicHealth fice ofResearch &DevelopmentOSIRES*VA HSR&D VEN Coordinating HubAdministrative CoreHealthInformatics CoreData &Methods CoreImplementation& Training CoreRapid Pilot PatientCenteredCareEHRMCouncils*OSIRES ORD Strategic Initiative for Research & EHR SynergyBreast CancerScreening andFollow-up

PROVEN OR RWGPROVEN HubOEHRM Research Work GroupHelps Research make scientificcontributions to EHRM.Helps Research continue to do workusing the EHR and its data.1. SUPPORT, PILOT, and PRIORITIZEEHRM research1. IMPACT. Impact and mitigation fortransitioning sites2. INTEGRATE. Research-EHR integration,such as for clinical trials3. SUSTAIN. Foster sustainability ofresearch data Understanding incoming data Advising about using new dataalongside legacy data4. ACCESS. Advocate for access to EHRdata for research use2. TRAIN and ADVISE in methods &informatics relating to EHRM3. CONNECT and COORDINATE. Serveas liaison4. DISSEMINATE EHRM researchfindings

PROVEN Coordinating HubRAPID PILOT PROJECTS

Impacts of Cerner Millennium oncommunication across specialty care referralsPI: Kristina Cordasco, MD, MPHLos Angeles, Center for Healthcare Innovation, Implementation and Policy (CSHIIP)Objective: Provide rapid feedback to guide stakeholder decision-making,including the Ambulatory Care Council, implementation sites, and VA sitesin subsequent Millennium transition waves.Methods: Mixed Methods (quantitative, interviews, direct observation/document review)Aim 1Aim 2Aim 3Assess Millennium’sreferral request processfor adherence withrecommended bestpracticesCompare frequency/typesof referral process delays orfailures during transition/implementation to preimplementationExplore primary andspecialty care providers’insights/ perceptions ofspecialty care referralrequest process

Understanding the Impact of EHR Transition onVA Inpatient NursingPI: Sarah Krein, PhD, RNAnn Arbor, Center for Clinical Management Research (CCMR)Objective: Explore how EHR transition effects the delivery of VA inpatientnursing care at one site, providing pilot data for a larger study andpractical insights to mitigate potential safety hazards and promote safe,high-quality care for hospitalized Veterans.Methods: Primarily qualitative, including direct observation, shadowing andfocus groups.Aim 1Aim 2Aim 3Develop preliminaryinsights for assessingimpact of EHR transitionon inpatient nursingcareExplore development ofEHR-relatedworkarounds or processadaptations by inpatientnursesAdapt and testfeasibility of previouslydeveloped time andmotion workflowassessment tool

Impact of Electronic Health Record Modernizationon Patient-Centered Care and Health PortalsPI: David Mohr, PhDBoston, Center for Healthcare Organization & Implementation Research (CHOIR)Research questions: How does VA’s transition to a new EHR influence patient care andhealth portal experiences? (e.g., improved, worse, similar) Do patient characteristics (e.g., use, conditions, demographics) interactwith EHR system to explain PCC and health portal experiences? Do provider characteristics (e.g., service type) interact with EHR systemto explain PCC?Aim 1Aim 2Examine routinely collectedoutpatient survey data, match tocharacteristics to examine changeover time (e.g., interrupted timeseries)Conduct data analyses withtargeted survey questions (preand post cohorts) to moreprecisely assess experiences

Formative Evaluation of EHRM CouncilsCo-PIs: Julian Brunner, PhD, MPH and Jeremy Shelton, MD, MSHSLos Angeles, Center for Healthcare Innovation, Implementation and Policy (CSHIIP)Background: VA configuration of Cerner guided by 18 councils and 100workgroupsObjective: Characterize EHRM Council structure, processes, lessonslearned with eye to informing improved Council effectiveness, efficiencyand sustainabilityMethods: Analysis of documents (meeting materials, administrativerecords) from OEHRM. Semi-structured interviews (n 20-30) with councilchairs and participants)Aim 1Aim 2Characterize councils' structureand processes: Describe councilstructure, governance, activitiesand relationships with VAIdentify lessons and helpful practicesfrom councils' initial activities: Identifyopportunities to sustain and improvecouncils’ effectiveness and efficiency

Barriers to External Mammogram Care Coordinationand Exploration of Clinical Informatics SolutionsCo-PIs: Kristine Lynch, PhD Salt Lake City (VINCI) andKristen Gray, PhD Puget Sound (Center of Innovation for Veteran-Centered and Value-Drive Care)Objective: To lay groundwork for future informatics solutions to carecoordination within CPRS, with an eye towards features of the Cerner EHRResearch problem: VA supports homegrown tools for ensuring mammogram follow-up and rescreening (i.e.,coordination) VA facilities rely on community providers for mammograms, complicating coordination Gaps in coordination can affect quality of care, patient outcomes, and potentially increasehealthcare expendituresAim 1Aim 2Aim 3Identify key variables tracked forexternal mammogram coordinationand describe common barriers andfacilitators to coordination acrossVA facilities.Quantify the availabilityand describe the structure,format, and location of keyexternal care coordinationvariables within the EHR.Describe barriers andfacilitators to external carecoordination among staff atnon-VA healthcare systemsthat use Cerner EHRs.

PROVEN Coordinating HubHEALTH INFORMATICSCOREMike Weiner, MD, MPHIndianapolis VA

Examples of Important EHRM Research Topics and Outcomes Research topicsSchedulingConduct of researchSafety and quality of careData quality, backward compatibilityTelehealthAttitudes and experiencesHuman factorsPortals and VeteransHealth information exchangeTrainingInformation foragingEfficiency & valueVisualization, alerts, decision-makingInnovation & translating findings intouseful practices & toolsInformatics workforceEHR governanceLearning Health System OutcomesSupport for patient-centered careAccess to analyzable dataAccess to careAccess to clinically usable dataCoordination and communicationDissemination and adoptionClinical outcomesFollow-up of diagnostic testingImplementation processMedical errors & adverse eventsPatient engagementReferrals & consultationsSafe prescribing of medicationsSatisfaction; turnover of cliniciansSpecific quality measuresSystem interoperability &incorporation of community dataUsability, efficiency, productivity, timePROVENhub@va.gov

Health Informatics CoreGuidance, feedback, & facilitationrelating to informatics researchScientistsBrian DixonJennifer GarvinDavid HaggstromMichael MathenyApril SavoyMike WeinerStaffHimalaya PatelJason LarsonAnita WrightConsultant: Hardeep Singh

Health Informatics CoreGuidance, feedback, & facilitationrelating to informatics research

Health Informatics CoreExamples of knowledge & expertise Informatics-related study design Measurement of informatics-oriented outcomes Identification of informatics-relevant variables or factors Evidence base about EHR modernization User interface, usability, workflow, cognitive taskanalysis, learnability, and usefulness

PROVEN Coordinating HubDATA & METHODS COREJessica Davila, PhDHouston VA

PROVEN Data and Methods CoreTechnical Consultations Provide consultations in EHRM-related qualitative andquantitative research methods Areas of expertise: study design, big data, healtheconomics, survey development, qualitative methods Facilitate methods collaborations for EHRM-relatedproposals Point to EHRM data information that can be used forgrant applications

PROVEN Data and Methods CoreResources for Researchers Links to commonly requested information on VIReCand VINCI websites Maintain searchable project registry with methodsand data-specific information Library of information regarding EHRM researchmethodology

PROVEN Data and Methods CoreConsults and referrals PROVEN partnership with VIReC and VINCI Coordinate consults and referrals to VIReC for EHRMdata issues Collaborate with VIReC on researcher guidancearound EHRM data PROVEN is not responsible for: Data provisioning (VINCI) Data access requests (DART) Data mapping (OEHRM with RWG review)

PROVEN Data and Methods CoreTraining One-to-one sessions with investigators Small group sessions Research & EHR Synergy cyberseminar series (inpartnership with VIReC and OSIRES*) Training on topics related to EHRM researchmethodologies, based on needs of the field*OSIRES ORD Strategic Initiative for Research & EHR Synergy

PROVEN Data and Methods CoreVeteran Engagement Recognized impact of Cerner transition on careprovided to Veterans PROVEN Veteran Engagement Group: Understand priorities of Veterans related toCerner transition Input on EHRM-related grants involving Veterans Veterans voice in priority setting Process for requesting PROVEN VeteransEngagement Group review – details to come

Ways to get involved in the PROVENData and Methods Core Apply to participate inthe PROVEN Data andMethods Workgroup Submit e-mail ofinterest and CV toMichael Strayhorn atMichael.Strayhorn@va.gov Workgroup members: Hayden Bosworth Debra Choi Gemmae Fix Denise Hynes Jennifer Kramer Sarah Krein Matt Maciejewski John Piette Shubhada Sansgiry Maria Souden Brent Taylor

PROVEN Coordinating HubIMPLEMENTATION &TRAINING COREBecky Yano, PhD, MSPHVA Greater Los Angeles

PROVEN Implementation & Training VA’s EHRM (Cerner Millennium) largest EHRimplementation ever pursued (globally) Only EHRM implementation done during apandemic Opportunities for studying and enhancingimplementation extraordinary Requires better understanding of Cerner andOEHRM implementation plans

PROVEN Implementation & Training Support OEHRM/QUERI Partnered EvaluationInitiative Planning phase: Partner engagement, assessfeasibility, early site engagement, interviews Next phase: Formative evaluation of initialimplementation efforts in first wave VA sites Results used in multilevel stakeholder panel process tooptimize EHRM integration and implementation Pilot test tailored multicomponent strategy to improveEHRM outcomes in next wave sitesSeppo Rinne, MD, PhD & George Sayre, PhD (MPIs)

PROVEN Implementation & TrainingTechnical consults: Implementationstrategies Implementationevaluation Economicevaluation ofimplementation(HERC)****Current Hub partners

PROVEN Implementation & Training Coordinate linkages to partners and sites inpartnership with other PROVEN Cores

PROVEN Implementation & Training Library of area and organizational data Explore rapid data collection strategiesSusan Frayne, MD, MPH & Diane Carney, MA

PROVEN Implementation & Training Support dissemination with other Cores: Research & EHR Synergy cyberseminar series- implementation focused sessions Digestible summaries of research findings forpartners in and outside VA VA-authored journal supplement focused onEHRM research Accelerate EHRM-related implementationresearch/evaluation to help VA optimize Cernerimplementation

PROVEN Implementation & TrainingCore Members JoAnn Kirchner Julian Brunner Laura Damschroder Isomi Miake-Lye Alison Hamilton Kristina Cordasco Kyler Godwin Jeremy Shelton

What can the PROVEN Hub do for you? Technical consults with array of EHRM experts Training/technical support on developingEHRM-related research methods/proposals Help with identifying OEHRM and otherpartners and recruiting/engaging VA facilities Facilitate EHRM research collaboratives Support dissemination and knowledge transfer Contact us at PROVENHub@va.gov

Electronic Health Record ModernizationResources for Researchers“EHRM & Research” page on the Research Resource Guide ugResearch/RRG/Pages/EHRM-Research.aspx“EHRM and Implications for Data Users” page on the VIReC rview-and-Implications.htm“Data Management and Migration Knowledgebase” on the Data Migration,Management, and Syndication areHome.aspxSyndicated Data Bits - Weekly WebinarsSession ArchiveOffice of Electronic Health Record Modernization (OEHRM) Intranet sitehttps://vaww.ehrm.va.gov/Research & EHRSynergy

Questions?Contact us v/centers/proven.cfm

using the EHR and its data. 1. IMPACT. Impact and mitigation for transitioning sites 2. INTEGRATE. Research-EHR integration, such as for clinical trials 3. SUSTAIN. Foster sustainability of research data Understanding incoming data Advising about using new data alongside legacy data 4. ACCESS. Advocate for access to EHR data for .

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