1014 — The CART Story: Facilitators and Barriers to Successful HIT Implementation

Box TL (IHD-QUERI), McDonell M (IHD-QUERI), Helfrich C (IHD-QUERI), Jesse R (Patient Care Services), Fihn SD (Office of Quality and Performance), Rumsfeld JS (IHD-QUERI)

Objectives:
The VA Cardiovascular Assessment Reporting and Tracking (CART) system is a collaboration of IHD-QUERI, Patient Care Services, Office of Quality and Performance, and the Office of Information (now OI&T). CART is the national reporting software, data repository, quality and management system for the 76 VA cardiac cath labs. CART has been successfully developed and nationally implemented, though with variation in process and adoption. This workshop will relate lessons learned from CART - facilitators and barriers to the implementation, as well as case studies of other health information technology (HIT) implementation.

Activities:
Interactive presentation with concurrent discussion, using examples from CART implementation as a model: 1) Planning and Initiation: a) Gap Analysis – Identifying the need, b) Proof of Concept – Demonstrate a prototype, and c) Transactional Model –system integration. 2) Strategic Collaborations and Buy-in: a) CART collaborative process, and b) Local Buy-in –local clinical and technical champions. 3) What are the best “carrots” for key stakeholders?: a) Standardized reporting, b) Local / national quality efforts, c) Research potential, and d) Workload capture. 4) Installation: a) One VA, dozens of IRMS, and b) Activating local champions. 5) Moving from “Installed” to “Adopted”: a) The CART-CL Clinical In-Service model, b) Buy-in again – leaders/committees to guide the future of the system, c) Necessary Intolerance, i) Sometimes a national directive is required, ii) Co-existing systems, iii) Managing partial adopters, and d) Certification and Accreditation. 6) Case studies of HIT Failures: a) Failure to define success factors – “the never-ending project”, b) Failure to create, transactional workflow – turnkey versus customized solutions, c) Managing partial adopters – knowing which carrots and sticks work, and d) Inability to change/grow/adapt.

Target Audience:
Workshop intended for any group attempting to improve patient safety, efficiency, effectiveness, timeliness, or quality of care through information technology. Special emphasis will be placed on operational collaboration.

Assumed Audience Familiarity with Topic:
A basic knowledge of VA organizational structure is assumed. Specific technical knowledge is not required; workshop will focus on implementation strategies and not on technical specifications, HIPAA, or electronic transmission regulations.