title: Informatics implementation in the Veterans Health Administration (VHA) healthcare system to improve quality of care.
abstract: We describe VHA's information technology (IT) implementation from the providers' perspective, and identify factors influencing its effective implementation to improve care. We surveyed a stratified random national sample of 4227 clinicians from three VHA primary care provider groups: 1) physicians; 2) nurse practitioners, physician assistants; and 3) nurses. Facility-level IT support availability was rated across six dimensions: 1) access to literature/evidence, 2) computerized decision support, 3) computerized clinical data, 4) error reduction, 5) provider communication, and 6) patient communication. Factor analysis identified a 5-item scale (IT clinical support, á = 0.76). Generalized estimating equation models identified factors influencing IT clinical support. Complete data from 123 hospitals (1777 providers) were included. IT clinical support was higher in urban hospitals (p<0.05) and those with cooperative cultures (p<0.01). Opportunities exist to enhance effective use of IT to support clinical decision making, electronic communication with patients and access to recommendations while delivering care.
authors.affiliation: VA HSR&/D Center on Implementing Evidence-based Practice, Roudebush, VAMC, Indianapolis, IN, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Vaughn
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: McCoy
authors.forename: Peter
authors.initials: P
authors.lastname: Glassman
mesh_terms: D019033:Delivery of Health Care, Integrated; D005163:Factor Analysis, Statistical; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data; D016347:Medical Records Systems, Computerized; D015279:Organizational Culture; D009936:Organizational Innovation; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D014481:United States; D014493:United States Department of Veterans Affairs