Research article
'To take care of the patients': Qualitative analysis of Veterans Health Administration personnel experiences with a clinical informatics system
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* Corresponding author: Laura M Bonner Laura.bonner@va.gov
1 Health Services Research and Development Northwest Center of Excellence for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, Seattle, WA, USA
2 Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
3 Independent Consultant, Cambridge, MA, USA
4 Health Services Research and Development Center for Mental Healthcare and Outcomes Research, North Little Rock, AR, USA
5 Health Services Research and Development Center of Excellence for the Study of Health Care Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
6 School of Public Health, University of California, Los Angeles, CA, USA
7 VA South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
8 University of Arkansas for Medical Sciences, Little Rock, AR, USA
9 Health Services Research and Development Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
Implementation Science 2010, 5:63 doi:10.1186/1748-5908-5-63
Published: 20 August 2010Abstract
Background
The Veterans Health Administration (VA) has invested significant resources in designing and implementing a comprehensive electronic health record (EHR) that supports clinical priorities. EHRs in general have been difficult to implement, with unclear cost-effectiveness. We describe VA clinical personnel interactions with and evaluations of the EHR.
Methods
As part of an evaluation of a quality improvement initiative, we interviewed 72 VA clinicians and managers using a semi-structured interview format. We conducted a qualitative analysis of interview transcripts, examining themes relating to participants' interactions with and evaluations of the VA EHR.
Results
Participants described their perceptions of the positive and negative effects of the EHR on their clinical workflow. Although they appreciated the speed and ease of documentation that the EHR afforded, they were concerned about the time cost of using the technology and the technology's potential for detracting from interpersonal interactions.
Conclusions
VA personnel value EHRs' contributions to supporting communication, education, and documentation. However, participants are concerned about EHRs' potential interference with other important aspects of healthcare, such as time for clinical care and interpersonal communication with patients and colleagues. We propose that initial implementation of an EHR is one step in an iterative process of ongoing quality improvement.