• Ellen A Ahlness, Jay Orlander, Julian Brunner, Sarah L Cutrona, Bo Kim, Brianne K Molloy-Paolillo, Seppo T Rinne, Justin Rucci, George Sayre, and Ekaterina Anderson.
• Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle VA Medical Center, Seattle, WA, USA. Ellen.A.AhlnessAbdulmuminov@va.gov.
• J Gen Intern Med. 2023 Oct 1; 38 (Suppl 4): 991998991-998.

BackgroundElectronic health record (EHR) transitions are increasingly widespread and often highly disruptive. It is imperative we learn from past experiences to anticipate and mitigate such disruptions. Veterans Affairs (VA) is undergoing a large-scale transition from its homegrown EHR (CPRS/Vista) to a commercial EHR (Cerner), creating a unique opportunity of shedding light on large-scale EHR-to-EHR transition challenges.ObjectiveTo explore one facet of the organizational impact of VA's EHR transition: its implications for employees' roles and responsibilities at the first VA site to implement Cerner Millennium EHR.DesignAs part of a formative evaluation of frontline staff experiences with VA's EHR transition, we conducted brief (~ 15 min) and full-length interviews (~ 60 min) with clinicians and staff at Mann-Grandstaff VA Medical Center in Spokane, WA, before, during, and after transition (July 2020-November 2021).ParticipantsWe conducted 111 interviews with 26 Spokane clinicians and staff, recruited via snowball sampling.ApproachWe conducted audio interviews using a semi-structured guide with grounded prompts. We coded interview transcripts using a priori and emergent codes, followed by qualitative content analysis.Key ResultsUnlike VA's previous EHR, Cerner imposes additional restrictions on access to its EHR functionality based upon "roles" assigned to users. Participants described a mismatch between established institutional duties and their EHR permissions, unanticipated changes in scope of duties brought upon by the transition, as well as impediments to communication and collaboration due to different role-based views.ConclusionsHealth systems should anticipate substantive impacts on professional workflows when EHR role settings do not reflect prior workflows. Such changes may increase user error, dissatisfaction, and patient care disruptions. To mitigate employee dissatisfaction and safety risks, health systems should proactively plan for and communicate about expected modifications and monitor for unintended role-related consequences of EHR transitions, while vendors should ensure accurate role configuration and assignment.© 2023. The Author(s).

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