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Videos of each of the five pitches will be available soon.

The AMIA 25x5 Task Force Vendor Workstream is building a five-year roadmap of HIT initiatives to reduce documentation burden and solicited innovative pitch ideas to include in the roadmap.

During this one-hour event, the top 5 ranked pitches from round one will each present a 3-minute pitch to a panel of judges.  The judges will determine the project included in the task force five-year roadmap of HIT initiatives that will be delivered with the support of AMIA’s 25x5 community.

Round Two Pitches

It is common for patients to fill out many forms when seeking care as a new or returning patient. These forms contain information that are essential in delivering high quality care. However, the process of gathering and translating that information into actionable care could be burdensome: the patient must complete a form, several members of the healthcare team must review and re-transcribe the from paper into the electronic health record (EHR), and then use that information to provide care. Manual processes take time and effort, delays care, and increase transcription error risk.

To reduce burden on our clinicians, convert all patient facing paper forms into an electronic form. The form can be completed by the patient via the patient portal, through a tablet in clinic or any patient handheld mobile device.  

After the patient submits the form, responses can be shared across other forms as needed and is integrated directly into the EHR. The clinicians will open their clinical note and responses will automatically populate their note.  The clinician will review, clarify, and verify with the patient and make changes as needed. This will be a bi-directional update between patient portal and the EHR. From the same note, referrals/orders (such as social work, chaplaincy, nutrition) or any actionable items are automatically generated, reducing end-to-end steps in the process.

Despite medical device enhancements, the documentation burden on caregivers in 2022 remains high. This creates a barrier to positive patient-to-caregiver relationships, negatively impacts the experience of the patient and contributes to the burnout of the caregiver.  Interoperability solutions that decrease the time spent documenting while supporting nurses’ clinical decision making, are solutions that will improve the patient experience, drive outcomes, and reduce clinician turnover.

Many devices in the clinical environment and connected to the patient are collecting valuable and insightful information but are limited in their ability to communicate that relevant information directly to the EMR.  Through vendor agnostic interfaces from Optical Character Readers to Serial Interfaces to Server Interfaces, our health IT company is automating the collection and documentation of vitals directly to the EMR to drive more time at the bedside, more time spent delivering care and less time spent in “data entry” mode.

Once data at the point-of-care is collected, it can be further automated by applying clinical decision support algorithms that support nurses in both their collaboration and care delivery decision making.  Application of these algorithms will provide early recognition of deterioration and contextual information around alerts for response prioritization.  In the drive to reduce the documentation burden we should be driven to support care delivery through the application of algorithms and present results through visualization tools that give caregivers actionable insights and reduce their cognitive workload across disparate clinical data sources.  

Through collection, analysis, and visualization, we propose to offer an automated, end-to-end, connected care and clinical collaboration solution that reduces the documentation burden, improves the accuracy of the data record, reduces the latency of available information, improves the patient experience, improves the clinician experiences, reduces care delivery costs, and most importantly, directly and positively impacts patient outcomes.

We have a robust governance structure at our health system which includes several bedside nurses. We currently document everything for patients which includes normal values in assessments. I am leading a project to move away from that practice and move towards documenting by exception by using the WDL method. However, there are several ways WDL (Within Defined Limits) can be implemented. We believe we have designed a good structure to help nurses reduce unnecessary documentation and support nurses only documenting on the required or needed assessment items. To start all assessment rows start collapsed under each main body system.

If exceptions are noted or selected, then nurses will select the specific assessments needed. Also, instead of documenting WDL on each assessment, we found that nurses feel obligated to continue documenting on assessments that have returned to normal. Instead, we will use the term "Return to WDL" so that nurses do not continue to document on once abnormal assessments. This project is in the design phase and we are engaging nurses from several inpatient areas to change the documentation practice in order to decrease the burden of documentation.

Thrive in Clinic is an advanced team-based EHR training program for ambulatory clinics. Our intent is to raise EHR proficiency for every staff member, standardize workflows, optimize Epic build, and ultimately improve patient experience. We are data driven, we report with transparency, and we aim to simultaneously reduce burnout and rekindle the joy of healthcare. We believe documentation burden encompasses not only time spent on documentation but the overall user experience, perceived ease of use, and EHR satisfaction.

We have found that engagement in efficiency and optimization training is greatest when facilitated by like-roles and when the entire clinic is included. Our training team gets to know each clinic prior to our training program through questionnaires and observation. The curriculum is developed based on our discovery period with each clinic and also includes our core, standardized educational topics. Training is provided through one-to-one and group sessions over a two-week period.

Effectiveness of our program is measured primarily with survey responses gathered by a third party.   Group teamwork, cooperation, level of burnout, factors contributing to burnout, ease of use, ability to prevent mistakes, and accessibility to data are some of the measures that we track.  We have seen a 21 percent increase in the Net EHR Experience Score with the clinics that we have worked with thus far.  We have also seen improvements in communication, teamwork and a reduction in burnout.  Quantitative measures of documentation time and efficiency tools are also possible through data curated by our EHR vendor.

Our program started as a small pilot, and we have grown to a fully-funded department.  We believe our training model is scalable and it is imperative to reduce documentation burnout for all clinicians and staff.

Current documentation paradigms are modeled after paper charts & encounter based care.  Though care is provided on a continuum and by teams instead of by individuals, daily progress notes on the inpatient side & per visit notes in ambulatory, require clinicians to duplicate entire sections of their patient care plans for each encounter, often by multiple team members. It is not surprising that research shows about 50.1% of EHR text is directly duplicated from a prior note (pending publication in JAMA Network Open, Steinkamp, J. Et al).  Additionally, current EHR models do not have the concept of a patient-centric to do list.  I.e. what needs to get done for the patient, why, by whom, and what is the status?  Instead, most systems rely on messaging, sticky notes, email and texting to keep track of who is doing what.  This is inherently duplicative and disorganized, leading to inefficiencies, communication failures, and important information being lost in these other communication methods, never making it into the patient’s record.

While care delivery models have changed, our documentation structure has not. We propose a different type of written communication and documentation paradigm that supports team-based care, iterative care planning, and cross care setting collaboration, while still meeting documentation requirements of encounter based charting.

What does that look like?

Building off the concept of the problem oriented medical record (PROM), a large quaternary academic center created a team collaboration platform with a wiki-based care planning tool.  Organized around a patient’s problems or diagnoses, the wiki contains semi-structured elements including problem names, plans (assessment of the problem, differential, updates, relevant data), action items to carry out that plan, as well as a patient-level one-liner summary statement.  The semi-structured elements enable clinicians to flag any item as being important anticipatory guidance for all care team members to  be aware of, or being related to transitions in care and more.   Tasks can be identified as being primary team tasks, on call tasks, they can be dated, timed, assigned etc.  This enables the wiki to be sorted and viewed based on different workflows such as TCM visits, post-discharge follow ups, or on the inpatient side rounding, handoff and more. Typically these different workflows are supposed by paper lists, sticky notes, in basket messages, email and more.  Instead of relying on these piecemeal modes of organization, this wiki model incorporates the plan and tasks within the care plan, while still allowing clinical teams and staff to view “just the tasks” of what needs to get done, without having to keep track of these separately.

Think of this as a living, breathing, wiki-plan of care... or progress note that anyone can see, anyone can edit, anyone can contribute to as a working document. At any time, the plan can be reviewed, captured and saved in the EHR as an encounter note (for inpatient OR outpatient). Meanwhile, the wiki captures work done between outpatient encounters and between inpatient daily notes, so that when the next note is written, it already incorporates all the change sin the plan since the last note, instead of requiring the clinician to start from an already outdated plan and have tore-write all the updates that took place since then - pulling form email, in-basket, text, paper and more.  At any time, once the plan is updated, a snapshot of it can be brought into the EHR progress note, leveraging already existing progress note templates, and eliminating double documentation.

This wiki-style documentation workflow has been in use on the inpatient side at a large quaternary academic center, across specialties, disciplines and facilities.  It is now also used in post-acute care settings, home care and value based care, with the same results of time saved, improved team collaboration, less errors and improved diagnosis capture. The application used for these sites is device agnostic, EHR agnostic, and care setting agnostic. It is intuitive and easily learned: most clinicians report feeling comfortable using it within 1 shift after watching a brief 10m video. Pilot implementation of this work has been published in ACI.

Judges

  • Bonnie Adrian, PhD RN-BC
  • Vince Hartman, MS
  • Andy Gettinger, MD, Professor
  • Ross Koppel, PhD, FACMI
  • Yaa Kumah-Crystal, MD, MPH, MS
  • Susan McBride PhD, RN-BC, CPHIMS, FAAN
  • Molly K. McCarthy MBA, RN-BC
  • Christine A. Sinsky MD FACP
  • Jeff Wall, MD
  • Michael Wang
  • Adam Wright, PhD, FACMI, FAMIA, FIAHSI
Dates and Times: -
Type: Webinar
Course Format(s): Live Virtual
Price: Free
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