Evidence map›Paper›PMID 39255006›Full record

ArticleJMIR formative research2024

User Experiences of Transitioning From a Homegrown Electronic Health Record to a Vendor-Based Product in the Department of Veterans Affairs: Qualitative Findings From a Mixed Methods Evaluation.

Ekaterina Anderson, Megan Moldestad, Julian Brunner, Sherry Ball, Christian Helfrich, Jay Orlander, Seppo Rinne, George Sayre

Abstract read
In one paragraph

Article in JMIR formative research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Tensions in large-scale electronic health record implementations: insights from a meta-synthesis.Journal of the American Medical Informatics Association : JAMIA · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ekaterina AndersonCenter for Health Optimization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.ORCID 0000-0001-7109-3054
Megan MoldestadVeterans Affairs Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.ORCID 0000-0002-0239-6120
Julian BrunnerVeterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, United States.ORCID 0000-0002-0878-5178
Sherry BallVeterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, United States.ORCID 0000-0002-2362-9499
Christian HelfrichVeterans Affairs Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.ORCID 0000-0002-9827-4768
Jay OrlanderChobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States.ORCID 0000-0003-0204-8449
Seppo RinneCenter for Health Optimization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States.ORCID 0000-0002-8662-1224
George SayreVeterans Affairs Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.ORCID 0000-0001-9378-5019

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe Department of Veterans Affairs (VA), the largest nationally integrated health system in the United States, is transitioning from its homegrown electronic health record (EHR) to a new vendor-based EHR, Oracle Cerner. Experiences of the first VA site to transition have been widely discussed in the media, but in-depth accounts based on rigorous research are lacking.

objectiveWe sought to explore employee perspectives on the rationale for, and value of, transitioning from a VA-tailored EHR to a vendor-based product.

methodsAs part of a larger mixed methods, multisite, formative evaluation of VA clinician and staff experiences with the EHR transition, we conducted semistructured interviews at the Mann-Grandstaff VA Medical Center before, during, and after going live in October 2020. In total, we completed 122 interviews with 26 participants across multiple departments.

resultsBefore the new vendor-based EHR went live, participants initially expressed cautious optimism about the transition. However, in subsequent interviews following the go-live, participants increasingly critiqued the vendor's understanding of VA's needs, values, and workflows, as well as what they perceived as an inadequate fit between the functionalities of the new vendor-based EHR system and VA's characteristic approach to care. As much as a year after going live, participants reiterated these concerns while also expressing a desire for substantive changes to the transition process, with some questioning the value of continuing with the transition.

conclusionsVA's transition from a homegrown EHR to a vendor-based EHR system has presented substantial challenges, both practical and cultural in nature. Consequently, it is a valuable case study for understanding the sociotechnical dimension of EHR-to-EHR transitions. These findings have implications for both VA leadership and the broader community of policy makers, vendors, informaticists, and others involved in large-scale health information technology implementations.

Indexed as

Electronic Health RecordsQualitative ResearchUnited States Department of Veterans AffairsCommerceFemaleHumansMaleUnited Statesdelivery of health careelectronic health recordsintegratedmedical informaticsorganizational changeUnited States Department of Veterans AffairsVeterans Affairs

Identifiers

PMID39255006
PMCPMC11422731

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.