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Barriers and Facilitators to Computer Use in VA for Implementing Guidelines

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)

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Barriers and Facilitators to Computer Use in VA for Implementing Guidelines

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  1. 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

  2. Focus Groups • 19 VAMCs: Theoretical Sampling (Hi/Low) • 50 Focus Groups 3/ site • Administrators • Primary Care Providers • Clinicians • Major Stakeholder Variation: • Barriers/ Facilitators to CPG implementation

  3. Major Barriers for All Stakeholders • Data Location • Essential Data • Computer Glitches • User Friendly • Computer Literacy • Attitudes • Workload

  4. Personal Concerns 7 Themes • Time • Attitudes • Workload • Computer Literacy • Computer Complaints • Workflow • Intrusiveness

  5. Issue MD RN Adm Major focus Continuity of care ▲ CPG Compliance ▲ Patient benefits ▲ Major Focus by Stakeholder Group

  6. 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.

  7. Providers' Assessment Regarding the Extent Their Hospitals Provide IT for Key Dimensions of Practice

  8. Results • 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.

  9. Results • 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

  10. Types of Computerized Clinical Reminders Across Facilities (n=104)

  11. Experiences with Clinical Reminders (Open-ended) Has an automated clinical reminder ever helped you deliver care more effectively? 63% Yes Have you ever been surprised by the actions of any computerized clinical reminders in CPRS? 24% Yes

  12. Barriers

  13. Computer Use to Implement Guidelines • Wins: • Widely implemented electronic patient record, order entry • Significant gains in performance measures • Losses: • Widespread computer use impacts provider-patient communication, teamwork • Errors: • Focus on documentation to exclusion of system change • Lack of consensus on how to effectively use computers • Ties: • Uncertainty regarding optimal use, benefits/tradeoffs • Sustainability for chronic care management uncertain

  14. Questions? Comments: Brad Doebbeling (317) 554-0000, 4493 bdoebbel@iupui.edu

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