Clinical Standardization Across a National Health System: Perspectives From the Veterans Affairs’ Electronic Health Record Transition

2026-06-09

PRE

Julian Brunner *

Bilodeau, Courtney MPH‡

Molloy-Paolillo, Brianne PhD‡

Helfrich, Christian D. PhD, MPH§

Dashtestani, Krista BA‖

Cohen-Bearak, Adena MEd, MPH‡

Hauck, Jan David PhD *

Herout, Jennifer PhD¶

Fuller, Helen PhD¶

Nebeker, Jonathan R. MD, MS¶, #

Cutrona, Sarah L. MD, MPH *

Rinne, Seppo T. MD, PhD‡, ††

DOI：10.1097/MLR.0000000000002319

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Abstract

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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.

Keywords:

standardization

clinical information systems

implementation research

organizational change

mixed methods

veterans

Clinical Standardization Across a National Health System: Perspectives From the Veterans Affairs’ Electronic Health Record Transition

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