Health professions trainee experiences transitioning to a new Federal Electronic Health Record: applying learning health system principles to support change management in the Veterans Health Administration

Abstract

Abstract Objective Electronic health record (EHR) transitions disrupt health system workforces. Health professions trainees (HPTs) play a critical role in providing care yet are under-addressed during transitions. We apply learning health system (LHS) principles to improve HPTs’ training experiences during the Veterans Affairs nationwide EHR transition. Materials and Methods We established a learning community to conduct a mixed-method quality improvement evaluation of HPT user experiences at 2 VA EHR transition sites, translating lessons learned from the first site into interventions for the second. We conducted semi-structured interviews (n = 90) and fielded surveys (n = 139) before and after site transitions (2/2022-4/2023; 1/2024-6/2024). We coded interviews and survey free text using a priori and emergent codes for content analysis. We conducted descriptive statistical survey analysis and merged data streams. Results At an earlier transition site, key challenges included delayed EHR access, irrelevant and prolonged training, limited live support, and reduced clinical training opportunities, impacting HPTs’ future career interests. Change management strategies—such as improved EHR provisioning, reduced training requirements, and expanded live support—resulted in fewer access issues, reduced training time, rapid EHR uptake, and maintained interest in VA careers. However, the relevance of training and operational communication still needs improvement. Discussion The LHS approach facilitated responsive change management by iteratively identifying and addressing key challenges, enhancing HPT experiences at subsequent transition sites. Effective change management can mitigate adverse impacts on HPTs, thereby supporting their clinical training and retention. Conclusions The LHS framework, through continuous learning and improvement, can support EHR transitions in large healthcare systems. This evaluation provides actionable insights to guide future transitions, ensuring better training experiences and outcomes for HPTs amidst significant organizational changes.

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