Article Figures & Data
Figures
- Figure 1.
Flow diagram of departmental EHR optimization process.
EHR = electronic health record; IT = information technology.
- Figure 2.
Longitudinal assessment of charges, payments, and visits in and around the time of the digital optimization project.
EHR = electronic health record.
Note: Data represented as a ratio of the monthly rate compared with the average monthly level of function prior to COVID-19 with 95% CIs (solid lines) and mean level (dotted line). Shaded areas represent shifts in baseline by Taylor’s change point analysis.
Tables
Preimplementation Empowerment from the department chair Set expectations for outcomes Freed adequate time from participants’ schedule Mandated participation in the dissemination process Created a vision Mission statement: Due to issues beyond our control, the EHR is here to stay. We, as a department, will move past the inertia of helplessness and improve the EHR by either molding it into a tool for our purposes or becoming agile enough to accommodate its imperfections. This will be accomplished through the following: Identifying imperfections in the way the EHR allows patient care Creating practical solutions to optimize physician workflow Allowing transparency of our innovation to the department and beyond Designating an individual to facilitate the project Engaging organizational IT resources Implementation Create multidisciplinary work groups for target areas in workflow Work Groups Composition of Work Groups by Rolesa Adiminstrators Care Coordinators Faculty IT Nurses Residents Pharmacy Front Desk Staff Social Worker Care coordination 0 1 3 1 1 1 1 0 1 Communication 0 0 3 1 2 1 0 1 0 Front desk 1 1 3 1 1 1 0 1 0 Medications 0 0 4 1 1 1 1 0 0 Notes 0 0 4 1 1 1 0 0 0 Nursing 0 0 3 1 3 1 0 0 0 Orders/referrals 0 1 4 1 2 1 1 1 1 Revenue 2 1 3 1 0 1 0 1 0 Meet Monthly Hourly standing monthly meetings for each work group for 4 months Project lead attended all meetings to provide inter-group insights Facilitated discussions sought to understand every facet of the workflow Optimizations created to optimize patient safety Changes were implemented immediately upon group consensus Assignments (testing and developing workflows) were carried out by work group members between meetings New issues were brought to the attention of work group chairs between meetings Dissemination Departmental dissemination meetings Mandatory Virtual format Participants utilized a dual screen computer format to allow for simultaneous experimentation Role-specific meetings (nurses, patient service representatives, and clinicians) IT staff also attended Individualized favorite order sets and templates Disseminated to new hires Institutional dissemination Real-time improvements shared with all departments Process presented at the institution’s annual Quality Improvement and Safety Conference EHR = electronic health record; IT = information technology.
↵a This table shows the number of individuals in each work group by role. Some served on more than 1 work group.
Work Group Overall No. (%) Accommodationsa No. (%) Creationsb No. (%) Discoveriesa No. (%) Modificationsd No. (%) By IT Total No. (%) By Dept. Total No. (%) All groups 124 (100) 43 (34.7) 13 (10.5) 54 (43.5) 14 (11.3) 27 (21.8) 97 (78.2) Care coordination 12 (9.7) 5 (41.7) 3 (25.0) 3 (25.0) 1 (8.3) 4 (33.3) 8 (66.7) Communication 20 (16.1) 4 (20.0) 4 (20.0) 9 (45.0) 3 (15.0) 7 (35.0) 13 (65.0) Front desk 30 (24.2) 21 (70.0) 2 (6.7) 7 (23.3) 0 (0.0) 2 (6.7) 28 (93.3) Medications 8 (6.5) 3 (37.5) 0 (0.0) 4 (50.0) 1 (12.5) 1 (12.5) 7 (87.5) Notes 17 (13.7) 0 (0.0) 1 (5.9) 15 (88.2) 1 (5.9) 2 (11.8) 15 (88.2) Nursing 21 (16.9) 15 (71.4) 1 (4.8) 5 (23.8) 0 (0.0) 1 (4.8) 20 (95.2) Orders/referrals 27 (21.8) 3 (11.1) 2 (7.4) 16 (59.3) 6 (22.2) 8 (29.6) 19 (70.4) Revenue 18 (14.5) 6 (33.3) 4 (22.2) 5 (27.8) 3 (16.7) 7 (38.9) 11 (61.1) Dept = department; IT = information technology.
Note: Duplicate optimizations were included in work group numbers if they independently originated in more than 1 group. The all groups row and overall column show numbers and percentages with duplicates eliminated.
↵a Accommodations and discoveries are adjustments made by the department outside of the EHR.
↵b Creations are workflows added to the EHR by IT.
c Discoveries are workflows found by the department already in the EHR.
↵d Modifications are workflows changed in the EHR by IT.
Accommodationsa Adjusted phone triage, removing the burden of all incoming calls going to the front desk
Changed rooming and documentation workflow
Standardized process for scanning documents into the EHR
Modified scheduling workflow to EHR capabilities
Creationsb Created a way to connect multiple printers for specific clinicians
Generated a function for attending billing attestations on resident notes
Developed a unified method for interdepartmental referrals
Designed an algorithm for attribution of patients to primary care clinicians
Created functions that closed the loop for completion of quality measures
Discoveriesc Uncovered functionality of a resource tab for quality measures
Identified filters for monitoring referrals, listing patients by site, and searching documents
Became aware of how to create prefabricated tests and laboratory orders
Discovered functionality for clinicians to view data when creating notes during patient visits
Found capability to extend search ranges for vital signs, laboratory, and test results
Modificationsd Extended time that unsaved data remains in system
Developed a connection to state immunization database
Added a permanent and adjustable code status icon to the patient information screen
Updated department-specific favorite lists for medications, labs, and tests for efficiency
Eliminated redundant edit lists for outgoing billing
EHR = electronic health record; IT = information technology.
↵a Accommodations are workflow adjustments made by the department outside of the EHR.
↵b Creations are workflows added to the EHR by IT.
↵c Discoveries are workflows found by the department already in the EHR.
↵d Modifications are workflows changed in the EHR by IT.
