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Understanding Patients’ Preferences and Experiences During an Electronic Health Record Transition

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

The Department of Veterans Affairs (VA) has embarked on the largest system-wide electronic health record (EHR) transition in history. To date, most research on EHR-to-EHR transitions has focused on employee and system transition-related needs, with limited focus on how patients experience transitions.

Objective

(1) Understand patients’ preferences for information and support prior to an EHR transition, and (2) examine actual patient experiences that occurred at facilities that implemented a new EHR.

Design

We used a two-step approach. We had discussions with geographically diverse patient advisory groups. Discussions informed semi-structured, qualitative interviews with patients.

Participants

Patients affected by the EHR transition.

Main Measures

We met with four patient advisory groups at sites that had not transitioned their EHR. Interviews were conducted with patients who received care at one of two facilities that recently transitioned to the new EHR.

Key Results

Patient advisors identified key areas important to patients during an EHR transition. 1) Use a range of communication strategies to reach diverse populations, especially older, rural patients. 2) Information about the EHR transition should be clear and reinforce trustworthiness. 3) Patients will need guidance using the new patient portal. From the patient interviews, we learned if and how these key areas mapped onto patients’ experiences. Patients at the sites that had transitioned learned about the new EHR through a variety of modalities, including letters and banners on the patient portal. However, their experiences varied in terms of information quality, leading to frustrations during and between healthcare encounters. Patient portal issues exacerbated frustrations. These raised concerns about the accuracy and security of the overall EHR.

Conclusions

Maintaining clear communication across patients, local leadership, and providers throughout an EHR transition is essential for successful implementation. Patient-facing communications can set expectations, and help patients receive adequate support, particularly related to the patient portal.

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Data Availability

The underlying data for this study consists of in-depth, qualitive interviews with detailed, potentially identifiable information about patients. The datasets generated and/or analyzed during this study are not publicly available due to participant privacy but may be available from the lead author on reasonable request.

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Acknowledgements:

We would like to thank the Rural Colorado Veteran Research Engagement Board affiliated with the Office of Rural Health’s Growing Rural Outreach through Veteran Engagement (GROVE) Center (Denver, CO); the Veteran Engagement Group at the Center for Healthcare, Organization and Implementation Research with VA Bedford and VA Boston Healthcare Systems (Bedford/Boston, MA); Greater Los Angeles Veteran Engagement Team (GLA VET) (Los Angeles, CA); and Veteran Engagement Group members affiliated with the Center for Innovations in Quality, Effectiveness and Safety at Michael E. DeBakey VA Medical Center (Houston, TX) for graciously hosting our team.

Funding

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (SDR 20–197-A; PIs: Fix/Davila). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. There are no conflicts of interest to report for any authors.

Author information

Authors and Affiliations

  1. Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Rd., Bedford, MA, USA

    Gemmae M. Fix PhD & Stephanie L. Shimada PhD

  2. Chobanian & Avedisian School of Medicine, Boston University, 72 E Concord St, Boston, MA, USA

    Gemmae M. Fix PhD

  3. Boston University School of Public Health, 715 Albany St., Boston, MA, USA

    Gemmae M. Fix PhD & Stephanie L. Shimada PhD

  4. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey VA Medical Center, 2450 Holcombe Blvd Houston, Houston, TX, USA

    Trenton M. Haltom PhD & Jessica A. Davila PhD

  5. Department of Medicine-Health Services Research, Baylor College of Medicine, One Baylor Plaza Houston, Houston, TX, USA

    Trenton M. Haltom PhD & Jessica A. Davila PhD

  6. Center for the Study of Health Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA

    Alison M. Cogan PhD

  7. Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, 1540 Alcazar St, Los Angeles, CA, USA

    Alison M. Cogan PhD

  8. UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, USA

    Stephanie L. Shimada PhD

Authors
  1. Gemmae M. Fix PhD
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  2. Trenton M. Haltom PhD
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  3. Alison M. Cogan PhD
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  4. Stephanie L. Shimada PhD
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  5. Jessica A. Davila PhD
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Corresponding author

Correspondence to Gemmae M. Fix PhD.

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Fix, G.M., Haltom, T.M., Cogan, A.M. et al. Understanding Patients’ Preferences and Experiences During an Electronic Health Record Transition. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08338-6

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  • DOI: https://doi.org/10.1007/s11606-023-08338-6

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