Becker's Hospital Review

49 INNOVATION Geisinger cuts ED note bloat by 40% By Naomi Diaz G eisinger, based in Danville, Pa., has achieved a 40% reduction in the average length of emergency department provider notes by using tools within its Epic EHR system. This decrease in note length was prompted by the changes in billing and reimbursement guidelines introduced by CMS in 2023, Kyle Marshall, MD, an emergency medicine physician and associate chief medical informatics officer for operations at Geisinger, told Becker's. To adapt to these changes, Geisinger decided to overhaul its ED note templates, which had been standardized across nine EDs over the past six years. The template was updated to replace lengthy historical sections with hyperlinks. These links open pop-up windows displaying past medical, surgical and social histories relevant to the current physician and patient encounter, thereby reducing note clutter while maintaining access to essential information, according to Dr. Marshall. Previously, providers used smart links to automatically include all lab results and radiology reports in patient notes. Geisinger disabled these links for the ED, replacing them with hyperlinks that offer quick access to results without overwhelming the note. In addition, Geisinger invested in provider education to ensure alignment with the new guidelines and to explain the rationale behind the changes to ED staff. As a result of the note length reduction, efficiency in Geisinger's EDs has improved. Dr. Marshall noted that provider efficiency profile reports indicate less time spent on documentation and increased efficiency scores over time. Furthermore, the changes have reduced note length without impacting billing levels, ensuring compliance with the new guidelines. Provider feedback to the changes has been largely positive, said Dr. Marshall, with many appreciating the simplified documentation process and the ease of using the updated Epic tools. The standardization has also enhanced the readability of notes for outpatient providers and patients, improving the overall experience. n children's hospitals. is market reality, combined with the complex needs of pediatric patients, oen results in solutions that either do not exist or are poorly adapted from adult care models. "Children can be quite complicated from a system perspective," Mr. Higginson said. Recognizing this, Phoenix Children's has prioritized in-house development to create customized soware solutions that are better suited to the specific needs of pediatric care. However, the hospital is careful to avoid the pitfalls of technical debt, which can occur when in-house solutions become obsolete or burdensome over time. To prevent this, Phoenix Children's employs a strategy that includes a clear exit plan for each project. "We're fully expecting, in three to five years, we're going to sunset that application and go acquire it from a vendor where it's more mature and sustainable," Mr. Higginson said. is approach, according to Mr. Higginson, allows Phoenix Children's to innovate rapidly, developing custom solutions to meet immediate needs while remaining open to adopting more mature, commercially available solutions as they evolve. In-house success stories Mr. Higginson highlighted two recent projects that demonstrate the benefits of Phoenix Children's in-house development strategy. e first is a home monitoring program designed to gather patient data between hospital visits, especially for the hospital's Medicaid population, where assumptions about access to technology can be misleading. Instead of relying on expensive equipment and complex setups, Phoenix Children's developed a simple text-based system that allows families to report key health metrics like eating habits and general well-being. is approach has led to high engagement and better management of complex conditions, as physicians can tailor follow- up schedules based on real-time data, Mr. Higginson said. Another is the overhaul of clinic intake forms. Recognizing that many of the forms were outdated and rarely used by physicians, the hospital streamlined the process to ensure that only relevant data points are collected, and these are directly integrated into the physician's notes. According to Mr. Higginson, this not only reduced the burden on patients but also improved the efficiency of clinical workflows. A consultative approach Phoenix Children's has also institutionalized a consultative process for deciding whether to build or buy technology solutions. Instead of starting with a pre-selected solution, the IT department encourages clinical and business teams to bring their problems forward and collaborate on finding the best approach. Mr. Higginson said this method ensures that the chosen solution — whether developed in-house or purchased — aligns with the hospital's strategic goals and effectively addresses the identified problem. n

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