Time tracking multi-site implementation of an electronic health screening program in VHA

Understanding the resources needed to implement digital health tools is critical for effective and sustainable transformation. For example, knowledge pertaining to the number of staff and amount of time spent on implementation activities is critical for planning and funding implementation efforts. Time–motion studies track both the time spent on a work task and what the task entailed. We conducted a time–motion analysis to examine the time and personnel needed for a multicomponent strategy used at 8 VHA sites to implement an electronic health screening technology (eScreening). Time-motion activity was tracked for the external research team and the 8 study sites. The research team used a Time Tracking Log Sheet to capture the time spent (rounded to the nearest 15-minute interval), the site and personnel involved, and the implementation activities. We examined the personnel (number) and time (hours) by study phase (Pre-Implementation, Training, Rapid Process Improvement Workshop [RPIW], and Ongoing Facilitation), site size (small versus large sites), and local versus research team. Data were analyzed in excel and SPSS using descriptive statistics and independent samples t-tests to examine differences between large and small sites. Average local team size and external research team size was 4 and 2, respectively, with no significant differences in the time spent in pre-implementation, training, RPIW, and ongoing facilitation between large and small sites. Both local and research teams spent approximately 30 h per person in total across all phases of implementation. The most time-intensive component was the 3-day RPIW (which involved stakeholder engagement, education, and the development of a site-adapted plan for eScreening implementation), averaging approximately 19 h per person for both teams. This study provides important information about strategies and resources to implement eScreening at VHA sites, which may also help inform the implementation of other digital health screening tools and related practices both within and beyond VHA. NCT04506164; https://www.clinicaltrials.gov/ ; recorded January 12, 2021.