Title: Barriers and Facilitators to Computer Use in VA for Implementing Guidelines
1Barriers and Facilitators to Computer Use in VA
for Implementing Guidelines
Brad Doebbeling, MD, MSc
VA Indianapolis HSRD Center of Excellence,
Indy VAMC Regenstrief Institute, Indiana
University School of Medicine Indianapolis, IN
2Focus 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
3Major Barriers for All Stakeholders
- Data Location
- Essential Data
- Computer Glitches
- User Friendly
- Computer Literacy
- Attitudes
- Workload
4Personal Concerns
- 7 Themes
- Time
- Attitudes
- Workload
- Computer Literacy
- Computer Complaints
- Workflow
- Intrusiveness
5Major Focus by Stakeholder Group
6National 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.
7Providers' Assessment Regarding the Extent Their
Hospitals Provide IT for Key Dimensions of
Practice
8Results
- 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.
9Results
- 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
10Types of Computerized Clinical Reminders Across
Facilities (n104)
11Experiences 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
12Barriers
Enough workstations in each clinician exam room? 82
Enough workstations for other staff in interview rooms? 68
Are formats tailored to specific populations? 45
Does computer speed impede use? 31
Lack of staff computer skills impedes use? 25
13Computer 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
14Questions?
- Comments Brad Doebbeling
- (317) 554-0000, 4493
- bdoebbel_at_iupui.edu