Streamlining Data Workflows Through EHR Optimization

CLINICAL DECISION SUPPORT INTEGRATIONS

Clinical decision support systems are often lauded as integral to putting the right information in front of the clinician at the right time. But this process can be fraught and, in fact, increase clinician burnout if that information isn’t relevant or alerts are overbearing.

Ajay Dharod, MD, vice chair of informatics and analytics for the Department of Internal Medicine at Wake Forest Baptist Health, co-created a clinical decision support tool that aims to mitigate clinician burden alongside his former colleague, Mark Frankel, MD.  

The WHIRL app automatically pulls together pertinent clinical information for providers for clinical decision support, eliminating the need to manually click through the EHR.

However, using clinical decision support can be tricky business. While its use has proven to improve clinical quality outcomes, clinical decision support can be detrimental to the provider.

Clinicians who may already struggle with EHR overload may experience clinical decision support alert fatigue, exacerbating clinician burden. Additionally, low-value EHR alerts can negatively impact patient care.

Dharod noted that he and Frankel were cognizant of ensuring that the application would be a help to clinicians, not a hinderance, by visualizing the data in a clinician-friendly format.

The system is discreet, Dharod noted, with messages appearing on the side of a physician’s screen rather than stopping physicians in their tracks.

“There are simply suggestions that float in to get you thinking about costs and options, and then float away to let the clinicians do what they do best, which is care for patients, with that nudge of decision support,” Dharod told EHRIntelligence in a July interview.  

Dharod said that time spent using the EHR has gone down and clinician EHR satisfaction has gone up at Wake Forest directly due to the EHR integration. He added that there has not been an increase in reported adverse events, as well.

Ultimately, the EHR integration has helped clinical providers save thousands of clicks per day, by eliminating tasks that were preventing physicians from working at the top of their license.

“This has been an incredibly valuable tool for clinical providers at Wake Forest,” Dharod explained. “Several of our residents, fellows, and faculty members say they get to spend an extra 20 to 30 minutes per day focusing on patient care as opposed to digging through the EHR.”

MEDICATION TRANSCRIPTION AND TRANSLATION

Disparate data sources are a leading cause of poor EHR usability, most experts agree. Clinicians who need to navigate different databases to understand patient health and care plans are often led to the EHR use fatigue that is so directly correlated with burnout.

Such was the cases at WellSpan Health. Prior to an EHR optimization at the Pennsylvania-based organization, patient records from external medication history sources were often incomplete, inconsistent, or missing, Robert Lackey, MD, FAAFP, WellSpan’s CMIO, told EHRIntelligence in a June interview.

This meant the organization needed to transcribe patient data back into the EHR, but the manual solution to that hurdle only posed to exacerbate the clinician burden problem.

This required a convoluted medication transcription process; employees had to reach out to pharmacists and other providers to gather medication data and then manually enter it into the EHR, presenting the opportunity for transcription errors and potential adverse drug events (ADEs), he explained.

To help streamline data workflows, the health system integrated MedHx, a health IT tool developed by DrFirst that provides a comprehensive medication database comprised of local and national medication history sources, including HIEs and EHR partners, directly in the native Epic EHR workflow.

The technology also identifies and connects local pharmacies and healthcare organizations that share mutual patients, making the dispensed fills available within the EHR and allowing for more comprehensive patient medication records.

While this solution aided in the medication transcription process, WellSpan still experienced the administrative burden of EHR translation.

Traditional patient data exchange is fraught with what Lackey referred to as the “yellow triangle syndrome.”

When patient data is sent from an EHR, it often comes in a different language than the receiving organization’s EHR, spurring yellow triangle notifications that indicate a manual data translation is needed.

For instance, one EHR may use the terminology “take by mouth” in a medication sig while a different EHR may say, “The route is oral, not by mouth,” he noted.

“It can take a ton of clicks and scrolling and selecting dropdown menus for a human to do that translation manually,” Lackey explained. “If you're expected to do a bunch of work, it decreases your efficiency, creates opportunities for errors, and that’s where your patient safety issues can show up.”

To automate the translation process, WellSpan leveraged the vendor’s AI solution SmartSig, which takes prescription transaction data and translates it into the native EHR nomenclature.

JUDICIOUS, TIMELY DATA INTEGRATION

EHR optimizations can help healthcare organizations respond to rapidly changing environments. Case in point, the demands the novel coronavirus place on healthcare in 2020 and 2021.

Mary Washington Hospital in Virginia is within driving distance of Washington DC, Maryland, Delaware, and Richmond, VA. Thus, the hospital was averaging roughly 2,500 COVID-19 vaccine shots per day.

As a medium-sized hospital, Mary Washington felt the burden of an overwhelming number of individuals coming in for vaccinations. Faced with limited resources, leaders converted a conference center on campus into a walk-in COVID-19 vaccine clinic and constructed tents for check-in.

Hospital leaders knew EHR optimization was in the cards to streamline the vaccination process and mitigate potential clinician burnout.

First, Stephen Hughes, director of IS technology at Mary Washington, attempted to leverage the organization’s EHR vendor to adapt to the rapidly changing environment. However, he noted that the organization took a different route to more swiftly optimize the EHR.

“The fact of the matter is, the EHR vendor has contactless scheduling and it was an option,” Hughes said. “In our case, given the little time we had to set it up, there was no way to get it set up fast enough for individuals who had never been to the EHR vendor-based hospital before. We had to find an alternate solution to quickly create a semi-integrated universe where this could fit together and get people through the system.”

Hughes and his team leveraged a popular restaurant booking app on top of its EHR system to enhance its patient scheduling and streamline the vaccination process.

“We looked at possibilities and the restaurant app offers API capabilities into the EHR to pre-populate and carry over patient information to the EHR,” Hughes continued. “Although there were other options or solutions, integration was too slow compared to the fact that we had to ramp up quickly at 2,500 people and then get them through these tests.”

Once the individual entered the “waiting area,” Hughes said it took roughly 25 minutes for the entire vaccine process. This time period was significantly less than it took pre-optimization.

Every healthcare organization faces its unique challenges; EHR optimization may be the key to tackling some of these clinical and administrative issues.