Abstract
This paper describes how the Veterans Health Administration (VHA), Office of Health Informatics (OHI) Human Systems Integration (HSI) team of human factors practitioners led a broad, multidisciplinary team to conduct a series of contextual inquiries at sites newly transitioned to Oracle Health Millennium, VHA’s new electronic health record (EHR)a at the request of VHA leadership. The team utilized contextual inquiry methods and principles of discount usability to identify system performance, workflow, and usability barriers for end users at live sites post-implementation of the new EHR. The VHA OHI and the VHA Electronic Health Record Modernization Integration Office (OEHRM IO) formed a team known as the Technical Get-Well Workstream to conduct rapid, semi-structured interviews and observations of clinical end users at several post-implementation VHA facilities to gather system performance and qualitative data documenting the end user’s experiences with the EHR. After each visit to the facilities, the team analyzed the data to identify core findings and make recommendations for remediation. The team produced user experience maps with collected data to visualize experienced system performance concerns. A key contributor to these efforts continued success is the application of discount usability methods to refine the scope and techniques of onsite data collection. This novel method ensures a carefully targeted scope, focusing on a small number of end user participants by asking targeted questions developed in advance, while at the same time capturing data during short interview and observation windows. The team continuously refined its method via after action reviews, lessons learned journals, and a strong practice committee, including study planning, logistics, onsite data collection, analysis, and reporting to reduce burden on hosting facilities and clinical participants.