Julian Brunner, Courtney Bilodeau, Brianne Molloy-Paolillo, Christian D Helfrich, Krista Dashtestani, Adena Cohen-Bearak, Jan David Hauck, Jennifer Herout, Helen Fuller, Jonathan R Nebeker, Sarah L Cutrona, Seppo T Rinne
{"title":"Clinical Standardization Across a National Health System: Perspectives From the Veterans Affairs' Electronic Health Record Transition.","authors":"Julian Brunner, Courtney Bilodeau, Brianne Molloy-Paolillo, Christian D Helfrich, Krista Dashtestani, Adena Cohen-Bearak, Jan David Hauck, Jennifer Herout, Helen Fuller, Jonathan R Nebeker, Sarah L Cutrona, Seppo T Rinne","doi":"10.1097/MLR.0000000000002319","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Clinical standardization is widely debated. Advocates emphasize its potential to reduce unwarranted variation and improve quality, while critics warn it may constrain professional judgment or undermine local innovation. These tensions become especially salient during enterprise-wide electronic health record (EHR) transitions, when configuration and workflow decisions can institutionalize practices across facilities. The Department of Veterans Affairs (VA), undertaking the largest EHR transition in history, provides a critical case for understanding how frontline staff perceive system-wide standardization.</p><p><strong>Objectives: </strong>To assess VA employee attitudes toward care process standardization during VA's enterprise-wide EHR transition and identify implementation challenges and opportunities.</p><p><strong>Research design: </strong>Cross-sectional survey with mixed-methods analysis of a survey fielded in September 2024.</p><p><strong>Subjects: </strong>We surveyed n=1748 EHR users at the first 5 VA sites implementing a new EHR.</p><p><strong>Measures: </strong>Awareness of and support for VA's Enterprise Standardization Initiative, assessed using 5-point Likert items; free-text comments were analyzed thematically to identify perspectives on standardization.</p><p><strong>Results: </strong>Among respondents, 43% reported awareness of VA's standardization initiative, and 65% supported standardizing care processes across facilities. Qualitative analysis revealed 3 themes: (1) support for standardization as complementary to EHR transition; (2) preference for decoupling standardization from technical change; and (3) emphasis on appropriately targeting standardization to preserve innovation capacity.</p><p><strong>Conclusions: </strong>VA employees expressed support for standardization with important caveats about implementation approach and scope. Findings support iterative standardization that balances consistency with local adaptation, while carefully sequencing standardization relative to technical change.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"64 7","pages":"442-446"},"PeriodicalIF":1.9000,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MLR.0000000000002319","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/6/9 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Clinical standardization is widely debated. Advocates emphasize its potential to reduce unwarranted variation and improve quality, while critics warn it may constrain professional judgment or undermine local innovation. These tensions become especially salient during enterprise-wide electronic health record (EHR) transitions, when configuration and workflow decisions can institutionalize practices across facilities. The Department of Veterans Affairs (VA), undertaking the largest EHR transition in history, provides a critical case for understanding how frontline staff perceive system-wide standardization.
Objectives: To assess VA employee attitudes toward care process standardization during VA's enterprise-wide EHR transition and identify implementation challenges and opportunities.
Research design: Cross-sectional survey with mixed-methods analysis of a survey fielded in September 2024.
Subjects: We surveyed n=1748 EHR users at the first 5 VA sites implementing a new EHR.
Measures: Awareness of and support for VA's Enterprise Standardization Initiative, assessed using 5-point Likert items; free-text comments were analyzed thematically to identify perspectives on standardization.
Results: Among respondents, 43% reported awareness of VA's standardization initiative, and 65% supported standardizing care processes across facilities. Qualitative analysis revealed 3 themes: (1) support for standardization as complementary to EHR transition; (2) preference for decoupling standardization from technical change; and (3) emphasis on appropriately targeting standardization to preserve innovation capacity.
Conclusions: VA employees expressed support for standardization with important caveats about implementation approach and scope. Findings support iterative standardization that balances consistency with local adaptation, while carefully sequencing standardization relative to technical change.
期刊介绍：
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.
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