barriers and facilitators to computer use in va for implementing guidelines
DESCRIPTION
Barriers and Facilitators to Computer Use in VA for Implementing Guidelines. Brad Doebbeling, MD, MSc. VA Indianapolis HSR&D Center of Excellence, Indy VAMC & Regenstrief Institute, Indiana University School of Medicine Indianapolis, IN. Focus Groups. 19 VAMCs: Theoretical Sampling (Hi/Low) - PowerPoint PPT PresentationTRANSCRIPT
Barriers and Facilitators to Computer Barriers and Facilitators to Computer Use in VA for Implementing GuidelinesUse in VA for Implementing Guidelines
Brad Doebbeling, MD, MScBrad Doebbeling, MD, MSc
VA Indianapolis HSR&D Center of Excellence, Indy VAMC & Regenstrief Institute,
Indiana University School of Medicine Indianapolis, IN
Focus Groups 19 VAMCs: Theoretical Sampling 19 VAMCs: Theoretical Sampling
(Hi/Low)(Hi/Low) 50 Focus Groups 3/ site50 Focus Groups 3/ site
AdministratorsAdministrators Primary Care Providers Primary Care Providers CliniciansClinicians
Major Stakeholder Variation: Major Stakeholder Variation: Barriers/ Facilitators to CPG Barriers/ Facilitators to CPG
implementationimplementation
Major Barriers for All Stakeholders
Data LocationData Location Essential DataEssential Data Computer GlitchesComputer Glitches User FriendlyUser Friendly Computer LiteracyComputer Literacy AttitudesAttitudes WorkloadWorkload
Personal Concerns7 Themes7 Themes TimeTime AttitudesAttitudes WorkloadWorkload Computer LiteracyComputer Literacy Computer ComplaintsComputer Complaints WorkflowWorkflow IntrusivenessIntrusiveness
Issue MD RN Adm
Major focus
Continuity of care ▲
CPG Compliance
▲ Patient benefits
▲
Major Focus by Stakeholder Group
National Provider Survey 4227 physicians, nurses, PAs and RNPs Primary & ambulatory care, medicine, nursing, and
geriatrics. Provider and organizational factors influencing guideline
adoption and adherence 139 VAMCs nationally. Provider attitudes, time, work organization, guideline-
specific data, implementation approaches, adherence tools, impact of tools on care, availability of IT, culture, support, audit/feedback.
Providers' Assessment Regarding the Extent Their Hospitals Provide IT for Key Dimensions of Practice
0.46
0.22
0.99
0.84
0.98
0
0.41
0.15
0.98
0.73
0.9
0.29
0.97
0.79
0.86
0.5
0.59
0.95
0.62
0.95
0.070.04
0.47
0.04
0
0.2
0.4
0.6
0.8
1
1.2
Access toLiterature/Evidence
Based Medicine WhileDelivering Care
Computer AssistedDecision Support
Systems
Computerized PatientClinical Data
Automation ofDecisions to Reduce
Errors
ElectronicCommunication
between Providers
ElectronicCommunication
between Providers andPatients
Perc
ent o
f Hos
pital
s with
Ave
rage
Res
pons
e of
Gre
at or
Ver
y Gr
eat (
> 3.
5)
Overall
Physician
PA/NP
Nurse
ResultsResults
46% indicated their hospital provided access to literature and EBM while delivering care.
22% computer assisted decision support systems (DSS) available.
Attitudes regarding ACR use very positive. --74% believed ACRs helpful in adhering to clinical guidelines. --Tools or templates to facilitate documentation nearly as high.
Interdisciplinary teamwork important in facilitating adherence.
ResultsResults
ACRs were not widely implemented across facilities. --44% had ACRs for diabetes mellitus. -- ~1/4 to provide recommended services for COPD and MDD.
Institutional factors associated with using IT: --Urban location--Cooperative culture
Types of Computerized Clinical Reminders Across Facilities (n=104)
Experiences with Clinical Reminders Experiences with Clinical Reminders (Open-ended)(Open-ended)
Has an automated clinical reminder ever Has an automated clinical reminder ever
helped you deliver care more effectively? helped you deliver care more effectively?
63% Yes63% Yes
Have you ever been surprised by the actions of Have you ever been surprised by the actions of
any computerized clinical reminders in any computerized clinical reminders in
CPRS? CPRS?
24% Yes24% Yes
BarriersEnough workstations in each clinician exam Enough workstations in each clinician exam room?room?
82%82%
Enough workstations for other staff in Enough workstations for other staff in interview rooms?interview rooms?
68%68%
Are formats tailored to specific populations? Are formats tailored to specific populations? 45%45%
Does computer speed impede use?Does computer speed impede use? 31%31%
Lack of staff computer skills impedes use?Lack of staff computer skills impedes use? 25%25%
Computer Use to Implement Guidelines Wins:Wins:
Widely implemented electronic patient record, order Widely implemented electronic patient record, order entry entry
Significant gains in performance measuresSignificant gains in performance measures Losses:Losses:
Widespread computer use impacts provider-patient Widespread computer use impacts provider-patient communication, teamworkcommunication, teamwork
Errors:Errors: Focus on documentation to exclusion of system changeFocus on documentation to exclusion of system change Lack of consensus on how to effectively use computersLack of consensus on how to effectively use computers
Ties:Ties: Uncertainty regarding optimal use, benefits/tradeoffsUncertainty regarding optimal use, benefits/tradeoffs Sustainability for chronic care management uncertainSustainability for chronic care management uncertain
Questions?
Comments: Brad DoebbelingComments: Brad Doebbeling
(317) 554-0000, 4493(317) 554-0000, 4493
[email protected]@iupui.edu