EHR Integration Streamlines Clinical Workflows, Care Coordination

An EHR integration helped streamline clinical workflows and care coordination at an academic hospital system, according to a study published in Applied Clinical Informatics.

Following a user-centered design strategy, researchers built and implemented a novel application to facilitate a good clinical workflow. The research revealed rapid clinician adoption and sustained usage of the EHR integration following implementation.

The study authors explained that most modern EHRs do not provide functionalities for collaborative, continuous plan updates and task management. Instead, much of clinicians’ minute-to-minute notations are performed outside of the EHR, often lost on paper.

Rather than emulating pre-existing paper workflows in a digital format, the researchers sought out to create a system, eventually dubbed Carelign, that leveraged digital technology and mobile devices.

“We attempted to match physicians' mental models more closely by designing Carelign to support updating the care plan more easily and frequently than is currently practical with daily progress notes. Doing so then helps the care plan record keep pace with patients' evolving conditions,” the authors wrote.

“This centralized care plan information can then serve multiple purposes across intersecting communication and documentation workflows,” they added. “It can populate rounding lists and handoffs, generate progress notes, and ultimately become a draft for the discharge summary.”

The researchers encountered several challenges to implementation, including availability of mobile devices and mobile device battery depletion. While Wi-Fi and cellular network coverage within clinical areas was adequate, clinicians experienced uneven coverage using the application on mobile devices in nonclinical areas such as hallways and elevators while en route to see patients.

This prompted efforts to improve network coverage to support ambulatory use, the authors said.

Additionally, replacing paper lists with a mobile tool in some instances led to a workflow mismatch when users needed to reference their lists on their mobile device during a phone call. While this was not an issue when using the application at a desktop workstation or workstation on wheels, using a mobile device occasionally required a workaround like using a landline or headphones for the phone call.

But ultimately, the researchers observed general user satisfaction with the EHR integration.

End-users reported that they were able to quickly learn to use the application. Clinicians also noted that the application improved their work experience and enhanced care coordination by increasing the safety and quality of their handoffs.

Clinicians could access Carelign from the EHR, computer workstations, and mobile devices. The study found that having mobile access to data increased the frequency with which teams accessed data on rounds, while requiring less login time.

“Use of Carelign increased over the course of our study, even after the health system's implementation of a system-wide integrated EHR,” the study authors noted. “Clinical groups quickly began to envision new uses and even structure quality improvement projects around the application.”

The study authors emphasized that the design of the application benefited from constant user feedback. During pilot phases, end-users provided application feedback via an online survey. However, this was poorly utilized. The researchers moved the mechanism to an in-application tool, which proved a more streamlined method for users to give feedback.

Key factors for success of this feedback mechanism were inclusion of user contact information and application metadata, timely responses to user issues and suggestions, and incorporation of ideas into the application when appropriate.

“We demonstrate that an EHR-connected data visualization and handoff tool that supports team-based care planning can be readily adopted and incorporated into clinical processes,” the authors wrote. “Continued studies of EHR-connected applications are needed to enhance clinician workflow and improve interactions and experience with EHRs.”