Study: Customizing EHRs to focus on quality, safety initiatives is complex

Customizing electronic health records to focus on quality and safety initiatives is complex and time-consuming, as Baylor Scott & White Health found in developing EHR fields to track evidence-based care processes to combat delirium in the ICU.

The Texas-based healthcare system was working with funding from the Agency for Healthcare Research and Quality to test the implementation of processes known as the ABCDE bundle at three of its hospitals, according to an article at eGEMs (Generating Evidence & Methods to improve patient outcomes).

These processes--daily awakening and breathing trials, formal delirium screening and early mobility--require coordination of care among physicians, nurses, and respiratory, physical, and occupational therapists. They were being tracked to determine best practices, according to the article.

Baylor Scott & White Health created a tab in the patient viewer to indicate which processes had and had not been performed, and to track effects of those processes over time.

While it initially wanted to create a business intelligence (BI) dashboard to allow ICU managers to pull bundle compliance data in real time, monitor key performance indicators, and provide feedback to frontline staff, due to resource constraints, the health system had to scale back the project to one creating monthly ICU reports.

Among the lessons learned:

  • Gaining buy-in from senior leadership was vital to securing resources for the project
  • The project took longer than planned: The development and testing cycle for the change requests to the EHR required nearly seven months before all components were ready for frontline use
  • It's critical to understand the varying workflows of the multidisciplinary care teams and to involve them in the EHR front-end redesign
  • Improving EHR interfaces will not improve data capture unless clinical staff are effectively trained on proper documentation and understand its importance. Periodic refresher training also was required

In a similar move, an initiative by the Crescent City Beacon Community in New Orleans created a five-step process to standardize the data extracted from EHRs to increase the reliability of quality measure reports.

"Our experience demonstrates that quality measure reporting from EHRs is not a straightforward process, and it requires time and close collaboration between clinics and vendors to improve reliability of reports," the researchers from the Louisiana Public Health Institute reported.

Fifteen years after the Institute of Medicine's watershed report "To Err Is Human," co-author Molly Joel Coye, M.D., chief innovation officer of UCLA Health at the University of California, Los Angeles, notes progress on reducing medical errors, but says information systems and electronic medical records systems are just reaching the point where they easily produce reports necessary to improve care.

To learn more:
- find the article (.pdf)