Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
Ann Fam Med. 2024 Mar 25;22(2):81-88. doi: 10.1370/afm.3073.
Electronic health records (EHR) have become commonplace in medicine. A disconnect between developers and users while creating the interface often fails to create a product that captures clinical workflow, and issues become apparent with implementation. Optimization allows collaboration of clinicians and informaticists after implementation, but documentation of success has only been at the institutional level.
A 4-month, department-wide EHR optimization was conducted with information technology (IT). Optimizations were developed from an intensive quality improvement process involving all levels of clinicians and clinical staff. The optimizations were then categorized as accommodations (department adjusted workflow to EHR), creations (IT developed new workflows within EHR), discoveries (department found workflows within EHR), and modifications (IT changed workflows within EHR). Departmental productivity, defined as number of visits, charges, and payments, was standardized to ratios prior to the COVID-19 pandemic and evaluated by Taylor's change point analysis. Significant improvements were defined as shifts (change points), trends (5 or more consecutive values above/below the mean), and values outside 95% CIs.
The 124 optimizations were categorized as 43 accommodations, 13 creations, 54 discoveries, and 14 modifications. Productivity ratios of monthly charges (0.74 to 1.28) and payments (0.83 to 1.58) significantly improved with the optimization efforts. Monthly visit ratios increased (0.65 to 0.98) but did not change significantly.
Departmental collaboration with organizational IT for EHR optimization focused on detailed analysis of how workflows can impact productivity. Discovery optimization predominance indicates many solutions to EHR usability problems were already in the system. A large proportion of accommodation optimizations reinforced the need for better developer-user collaboration before implementation. Early Access.
电子健康记录 (EHR) 在医学领域已经变得很普遍。在创建界面时，开发人员和用户之间的脱节常常导致无法创建一个能够捕捉临床工作流程的产品，并且在实施过程中会出现问题。优化允许临床医生和信息学家在实施后进行协作，但成功的记录仅在机构层面。
我们进行了为期 4 个月的、全部门范围的 EHR 优化，涉及信息技术 (IT)。优化是从一个涉及各级临床医生和临床工作人员的密集质量改进过程中开发出来的。然后，这些优化被归类为适应（部门调整工作流程以适应 EHR）、创造（IT 在 EHR 中开发新的工作流程）、发现（部门在 EHR 中发现工作流程）和修改（IT 在 EHR 中更改工作流程）。部门生产力，以就诊次数、收费和支付金额标准化为比率，在 COVID-19 大流行之前进行评估，并通过泰勒的变更点分析进行评估。显著改善定义为转变（变更点）、趋势（连续 5 个或更多值高于/低于平均值）和超出 95%CI 的值。
这 124 项优化被归类为 43 项适应、13 项创造、54 项发现和 14 项修改。优化工作使每月收费（0.74 至 1.28）和支付（0.83 至 1.58）的生产力比率显著提高。每月就诊次数增加（0.65 至 0.98），但没有显著变化。
部门与组织 IT 合作进行 EHR 优化，重点关注对工作流程如何影响生产力的详细分析。发现优化占主导地位表明，EHR 可用性问题的许多解决方案已经在系统中。大量的适应优化强化了在实施之前更好地进行开发人员与用户合作的必要性。早期访问。
