Optimization of Ambulatory Documentation in the Electronic Health Record
Informatics research conducted to optimize patient visit documentation in ambulatory (out-patient) offices. Work was presented at 2017 EPIC User Group Meeting (UGM).
[2016]
Since integration of a major Electronic Health Record (EHR) system in 2012, Parkview Health providers across specialties have been experiencing increased workload and frustration in completing office visit documentation with significant addition of work beyond office hours. The new system approach of presented conflict with established practice while no clear direction of best practices exists to date. A combination of data analysis and field study was conducted to identify and test best practices for visit documentation.
Team
Ryan Ahmed, Romisa R. Ghahari (Parkview Research Center)
Objective
Identify unique best practices by the most efficient users
Validate effectiveness of targeted training through a small-scale trial
Process
Analytics
The quality improvement initiative was planned to utilize a data-driven approach to identify, from a pool of 155 primary care providers, 16 most efficient users (“Cheese finders”, reference from the book Who Moved My Cheese by Spencer Johnson, MD) and 53 with most opportunity to improve through system use analytics.
Field Study
In-situ observations were used to study the work process of 8 Cheese Finders and 8 providers with most opportunity during office visits and identify differentiating practices of Cheese Finders adopted for visit documentation.
Training
Training materials were developed using best practices learned from the Cheese Finders. A small sample of 4 users with most opportunity was trained by Operations team as a pilot to collect efficiency data over a period of one month.
Comparative Data Analysis
Post pilot analysis was completed to compare the performance of pilot participants before and after the training and also against the Cheese Finders.
Only four providers volunteered for our training. Despite significant improvement for three, one had a decreased efficiency following training which impacted the average. Larger sample size could have compensated for what appears to be an outlier.
Outcome
Data analysis and participant feedback collected through surveys indicated success of the study and identified best practices for EHR visit documentation were reported to Operations team to be included in provider training.
Publications
Presented at 2017 EPIC User Group Meeting, Verona, WI.
