Issue link: https://beckershealthcare.uberflip.com/i/1460433
65 CIO / HEALTH IT Game-changing EHR improvements at UCLA, Intermountain and 6 other healthcare systems By Katie Adams A s the clinician burnout crisis continues, it's important that hospitals do all they can to optimize EHR workflows. Here, IT executives from eight health systems across the coun- try share the EHR workflow improvements that have saved their clinicians the most time. Editor's note: Responses were lightly edited for clarity and style. Ryan Smith. CIO at Intermountain Healthcare (Salt Lake City): Working in collaboration with our front-line nurses, we have been able to significantly reduce the documentation burden for physical assess- ment documentation in medical-surgical and critical care units. Our IT teams worked together with nursing teams to review and define essen- tial clinical documentation needs. is collaborative work resulted in redesigning the nursing documentation tool and workflow in our EHR. Results of the redesign for the Adult ICU Systems Assessment includ- ed an annual decrease of 11,101 hours of nursing documentation time and 27.4 million fewer clicks in the system. Similarly, improvements in the Adult Med Surg Systems Assessment included a reduction of 38,075 hours of nursing documentation time and 78.6 million fewer clicks. Finally, our Pediatric Physical Assessment nursing documenta- tion saw a reduction of 1,644 hours and 3.1 million fewer clicks in the system as a result of the redesign work. Rich Rogers. CIO at Prisma Health (Greenville, N.C.): A few years back, we saw the need to redesign how we screened for vaccination needs in the acute-care setting. ere was an update to pneumonia vaccines regarding who and when they qualified, and when flu vac- cines are required to be screened/administered in certain environ- ments. We had internal organizational goals to vaccinate as many patients as we could. Historically, it was a nurse-driven screening pro- cess, but there were a number of issues in the process. We created a workflow utilizing Epic and health maintenance. If the pa- tient had not received the appropriate vaccines (focusing on influenza and pneumococcal), the age and condition of the patient was consid- ered, and Epic would provide the pre-selected order that is appropri- ate for the patient in any admission order set used. It is then scheduled on the medication administration record, and the nurse does a final screening to ensure it was not received this year and there were no aller- gies. It reduced our nursing time drastically since they were no longer responsible for documentation and ordering, only the administration. We worked closely with our pharmacy team on a process to return "re- fused" vaccines to minimize wastage. We also embedded the vaccine information sheet into the workflow so the nurse was not required to search for it. If a patient has already received the vaccine, and it is docu- mented in Epic, then the order is never displayed. We also were the first in the state to have a bidirectional interface with our state agency to re- ceive vaccine data back into our EHR. is allowed the medical record to most accurately reflect the patient's vaccine status. Ellen Pollack, MSN, RN. Interim CIO and Chief Nursing Informat- ics Officer of UCLA Health (Los Angeles): In response to COVID- 19's increase in nurse workload, UCLA Health created and implement- ed special protocols to reduce medical record documentation burden and increase the time our nurses spend at the bedside. We made sig- nificant reductions in the amount of required documentation, keeping only those elements that were essential. Key considerations included patient safety, regulatory requirements and interprofessional commu- nication within the medical record. Aer conducting a pilot, we sur- veyed the nurses to get their feedback and made adjustments based on input. e special "disaster" protocols were then further deployed to all medical-surgical units, ICUs and the emergency department. We saw on average an 11 percent reduction in documentation time. No safety events were identified due to the decreased documentation. A survey of our nurses indicated that 88 percent reported they were able to spend more time with their patients. According to Ida An- derson, our director of nursing for adult critical care, clinical nurses expressed tremendous relief about the change. e change provided a tremendous relief. Disaster protocols oen made the difference be- tween working 12 hours per day compared to 13.5 hours. Nurses can focus directly on bedside care during these challenging times while knowing that the most important information is being communicated within the medical record. Nursing leadership monitors the use of this protocol carefully, and, when the workloads stabilize, they make the decision to return to standard nursing documentation. Michael Pfeffer, MD. CIO at Stanford Health Care (Palo Alto, Calif.): At Stanford Health Care, we are constantly optimizing the EHR to im- prove clinician efficiency through a collaborative effort with IT, infor- matics, clinicians and operational leads. One impactful improvement was the integration of our inpatient infusion pumps with our EHR. is project was designed to increase clinician efficiency and patient safety by automatically sending infusion medication orders from the EHR to the pump, and subsequently receiving infusion data from the pump to file back into the EHR. is removed the need for manual program- ming of the infusion pump and clinician documentation of the individ- ual infusion medication rate/volume information in the EHR. e largest impact to clinician efficiency can be seen in the ICU, where patients typically have several infusion medications running simultane- ously that need to be changed daily. It also increases patient safety by in- cluding the scanning of the pump as part of our closed-loop, barcoded medication administration process. Errors associated with medications are the most frequent cause of adverse medical events according to the Agency for Healthcare Research and Quality, and this project not only improved clinical efficiency but also patient safety. Eric Neil. CIO at UW Medicine (Seattle): With increasing demands on our providers from regulatory, quality, consumer and revenue sourc- es, combined with the recent pandemic, the clear path forward for healthcare IT is to provide solutions which maximize the benefits of team-based care. One of the primary functions of an EHR is to bring data together from those care team members into a clinically designed, consolidated format to facilitate both data review and documentation. On the inpatient side, we designed review summaries that clinically organize data around a patient's conditions, whether it is for a chronic disease like diabetes with our glucose summary reports, or an acute condition like our fever/infection reports. From the documentation side, we have constructed standardized templates to pull in and orga- nize all relevant information for that specialty, for that patient. Both have been shown to save clinicians time and improve outcomes. Stan- dardized order sets and clinical pathways support safe, effective and efficient care. Widespread use of electronic medication prescriptions improves patient safety and clinician efficiency, with one physician re-