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Barriers and Facilitators to Computer Use in VA for Implementing Guidelines

Gain insights into the challenges and opportunities surrounding computer use in implementing guidelines within the VA healthcare system. Explore key themes and stakeholder perspectives to understand barriers and facilitators to guideline compliance. Learn about provider attitudes, system glitches, workload concerns, and more affecting the adoption of clinical guidelines.

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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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