FEHRM Insight

Understanding Usability and Engagement to Enhance the Federal EHR

Dr. Janet E. Carter, FEHRM End-User Engagement Lead

The federal EHR represents the spine of modern health care infrastructure for the FEHRM’s federal partners. It offers unprecedented opportunities for improving patient care and operational efficiency. However, the transition to a modernized system is not without its challenges. Among the most critical issues facing the Departments is the usability and user experience of the federal EHR. How this digital tool is designed, its interface, and its functionality can significantly impact clinician and patient engagement, potentially influencing patient outcomes.

Usability refers to how easy and efficient it is for users to achieve their objectives within a system. In the context of systems, usability impacts how health care providers interact with the technology to deliver patient care.

While usability focuses on the effectiveness of system design, user experience encompasses the broader relationship between an EHR system and its users. A positive user experience in an EHR system can enhance job satisfaction among health care providers, reduce burnout, and encourage the adoption of technology. For patients, a good user experience can mean more meaningful interactions with their health care providers, potentially leading to improved health outcomes.

Engagement is also a critical factor in the successful implementation and use of EHR systems. For clinicians, engagement means more than just using technology; it involves understanding its capabilities, contributing to its improvement, and leveraging it to provide the best possible care. High usability and positive user experience are key drivers of clinician engagement.

For patients, engagement often revolves around how an EHR system enhances their interaction with health care providers and the care they receive. Patient portals, for example, are a critical component of EHR systems, offering patients access to their medical records, appointment scheduling, and communication with their health care providers. A user-friendly patient portal can empower patients, making them active participants in their health care journey.

The FEHRM plays a crucial role in enhancing engagement and usability of the federal EHR across various federal agencies. To support user adoption and engagement, the FEHRM employs several strategic initiatives, including implementing two congressionally mandated resources:

• End-user surveys gather essential feedback to identify areas needing improvement and ensure the system meets the practical needs of providers.
• Additionally, the Federal EHR Annual Summit offers a platform for stakeholders to connect, share insights, and collaborate on solutions to common challenges.

These efforts are critical for fostering a user-friendly environment that encourages widespread adoption and optimal use of the federal EHR, ultimately improving patient care and operational efficiency. The goal of any health care technology is to improve patient outcomes. The federal EHR has the potential to contribute significantly to this goal by providing high usability, positive user experience, and enhanced engagement for clinicians and patients. Additionally, the federal EHR can support population health management initiatives by providing data for analytics and enabling targeted interventions.

Despite the federal EHR's clear benefits, two main challenges include the diversity of users and their needs. Designing a system that meets the needs of various specialties, settings, and user preferences requires a careful balance between customization and standardization.

These are challenges the FEHRM looks forward to addressing with its partners as it refines and enhances the federal EHR. The presence and efforts of the FEHRM are not just imperative; they are transformative, steering the future of health care toward a more integrated, accessible, and patient-centered model.

References

Wiklund, M., Kendler, J., & Strochic, A. (2011). Usability Testing of Medical Devices. CRC Press.

Hibbard, J.H, & Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207-214.

Lovell FHCC Early Lessons Learned Showcase Adaptability of the Federal EHR

The deployment of the federal EHR in March 2024 at Lovell FHCC provides lessons learned for future federal EHR deployments, especially at other joint sharing sites. While the FEHRM continues to receive and evaluate these lessons learned, top themes include the following:

1. Ensure senior stakeholder and site engagement collaboration for success from planning to deployment. At Lovell FHCC, site leadership actively participated in collaboration with the FEHRM and the Departments.
2. Use the Enterprise Requirements Adjudication decision-making process to enable a strategy to manage and adjudicate process and procedural differences between Department policies, procedures, nomenclature, and workflows, and ensure all assessment findings are considered for inclusion in the federal EHR enterprise baseline.
3. Encourage training and adoption events participation and completion—focusing on such areas as workflows, differentiated modes of training, and an agile training content maintenance approach system design. Pay-It-Forward/peer coaching methodology is also imperative to improve end-user adoption, ensuring proficiency and minimal disruption to workflow.
4. Implement a more efficient and integrated workspace via MS Teams, Connect.gov and/or SharePoint that enables multi-agency access and real-time collaboration.
5. Accommodate dual-hat users—end users who render care on behalf of the Department that is not their employing Department—by working closely with Department identity and access management personnel and enhanced existing authentication pathways to allow end users to access the federal EHR using either Department’s credentials.

Work at Lovell FHCC and beyond continues to increase interoperability. Immediate focus areas to achieve greater integration include enhancing pharmacy, integrating help-desk processes, enabling training reciprocity, and defining roles and responsibilities for operational support during sustainment.

Further analysis of successes and lessons learned from the Lovell FHCC Go-Live will be documented in quarterly reports.

Now Available: Lovell FHCC Federal EHR Implementation Lessons Learned One-Pager and Report

Read the Lovell FHCC Initial Successes and Lessons Learned Executive Summary and the comprehensive Lessons Learned Summary Report to learn more about the federal EHR deployment at Lovell FHCC. Lessons learned from this groundbreaking experience will inform federal EHR deployments at future joint sharing sites.

Getting the Message Out

Now that deployment of the federal EHR is complete at Lovell FHCC, what’s next?

• Lovell FHCC is just the beginning of delivering the federal EHR as we build on our success and focus on joint operations at other sites.
• We deployed a set of workflows at Lovell FHCC that allows integration with VA and DOD clinical processes. We plan to go to other joint sites with these advantages and correct problems we introduced when DOD went live unilaterally. We can now harness the power of two organizations to drive better outcomes and advance interoperability.
• The FEHRM still continues to lead the multi-agency team for Lovell FHCC, providing support to the site after go-live through the transition to the sustainment phase.
• Barriers to convergence remain even after Lovell FHCC. We plan to address these remaining opportunities to enable Lovell FHCC and other sites to reach their integration goals.
• Our focus will also remain on listening to end-user feedback, so we can continue to refine and enhance the federal EHR. We will continue to focus on optimizing the federal EHR by looking at the data within the system.
• We look forward to building on the deployment of the federal EHR at Lovell FHCC to enhance the federal EHR for all joint sites that need joint solutions to effectively deliver care.

Visit the FEHRM website for more about the federal EHR and the FEHRM’s related work.

FEHRM Activities

FEHRM Leaders Join VA Deputy Secretary on VA Site Visits

In May, Mr. Tinston and Ms. Cori Hughes, FEHRM Program Integration Director, joined Ms. Tanya Bradsher, the VA Deputy Secretary, and other VA leaders and support staff on visits to all VA sites using the federal EHR—Columbus, Roseburg, Spokane, Walla Walla, and White City. At each site, end users provided feedback about the federal EHR and demonstrated what they learned to position themselves for success, including standardizing their own processes and identifying specific issues that need to be addressed. “The overwhelming sense I got was the positive commitment to getting this done and getting it done right,” Mr. Tinston said. He noted their willingness to share their experiences with others, availability to support Lovell FHCC’s federal EHR deployment, and commitment to help VA move ahead with national standards and implementations. Multiple sites acknowledged that deploying the federal EHR to other sites will improve their connectivity and ability to share data. They also expressed the need for a national shift away from supporting new initiatives in VA’s legacy systems and instead focus on the federal EHR. The FEHRM looks forward to upcoming additional visits to the sites needing assistance with specific pharmacy, technical, and other issues. Together, the team not only aims for better outcomes at all five sites but also getting VA out of reset and into restart mode.

Watch The State of the Federal EHR

In April, the FEHRM hosted The State of the Federal EHR, a virtual biannual event where federal leaders discuss the federal EHR. This event featured an update on the federal EHR deployment at Lovell FHCC. The discussion panel included Lovell FHCC leaders—Dr. Robert Buckley, Director, Lovell FHCC; CAPT Chad McKenzie, Commanding Officer, Navy Medicine Readiness and Training Command Great Lakes and Deputy Director, Lovell FHCC; and CAPT Salee Jane Oboza, Executive Officer, Navy Medicine Readiness and Training Command (Navy Component) and Associate Director for Readiness, Lovell FHCC. The virtual meeting also included a FEHRM and ONC Fireside Chat with Mr. John Short, FEHRM Interoperability Director, and Mr. John Rancourt, Deputy Director, Office of Technology, Office of the National Coordinator for Health Information Technology (ONC), during which they discussed interoperability and health information technology. Watch The State of the Federal EHR on the FEHRM website.

Watch The State of the Federal EHR on the FEHRM website.

Joke of the Quarter

When an employment application asks who is to be notified in case of emergency, I always write, “A very good doctor.”

The FEHRM Cartoon