Tool That Pulls Patient Information from EHR Streamlines Workflow
By Elizabeth Gardner
As a rule, many clinicians don't enjoy entering data into an electronic health record (EHR) system, but once the information is in there, it should make life easier in other ways. A research project at Bridgeport Hospital, Connecticut, tested this principle on pre-procedure documentation practices, and found that residents saved time and produced more accurate documentation when they used forms that had been populated with relevant information from the patient's EHR.
First, the study audited pre-procedure documentation for 29 ultrasound-guided procedures. The information was collected by residents using a standard form. A paltry eight percent of the forms adhered to American College of Radiology (ACR)/Society of Interventional Radiology (SIR) guidelines, which include the plan for each procedure to be performed, the indication for the procedure and a brief history, findings of targeted physical examination, lab results and other findings, risk stratification and documentation of informed consent.
After the audit, the residents met to figure out why their performance was so poor. "They didn't have enough time during the busy ultrasound rotation, and they weren't aware of the guidelines," said Daichi Hayashi, M.B.B.S., Ph.D., a resident in diagnostic radiology at Bridgeport Hospital, during a presentation of a Quality Storyboard on Wednesday.
Because much of the required information is already in the hospital's Epic EHR system, the research team used the vendor's "smartphrase" tool to create a pre-procedure form—a "proforma"—that appears in the residents' "favorites" list when they log into the EHR. The proforma automatically pulls all relevant available data from the patient's record and uses it to populate the procedure form according to the ACR/SIR specifications. Some data, such as documentation of consent, must still be added manually, but the data entry burden is substantially reduced.
After refining the form several times and putting it into the daily workflow so that residents could get used to using it, researchers tried it out with three residents, whom they presented with more than 30 hypothetical cases. Each resident did the documentation twice: once by searching the EHR manually for the relevant data and once using the pre-populated form. The two efforts were separated by several weeks so that memorization wasn't a factor.
Using the pre-populated form reduced the median documentation time per case from seven or eight minutes to two or three, and increased guideline adherence to 100 percent.
"Epic has been time consuming for physicians due to the extensive need for documentation, but this type of tool might streamline workflow, leaving more time for bedside patient care," Dr. Hayashi said.
The burden still falls on the resident to confirm the accuracy of the information from the EHR, such as the medication list, which Dr. Hayashi said he verifies with the nurses who have most recently taken care of the patient.
As to whether the pre-populated forms increase patient safety, Dr. Hayashi said the sample is too small to draw any conclusions. However, he credits the pre-populated form for preventing him from starting one procedure where there was no signed consent on file—a piece of information that he says he might have been overlooked in the old form.