How Phoenix Children’s structured its EHR to be disease specific to improve care, drive savings

An automated system within its EHR enables clinicians to capture 99 percent of notes in a structured format, as opposed to free-text, virtually eliminating the need for transcription and making EHR content more searchable.

Phoenix Children's structured EHRs to be disease specific to improve care

Phoenix Children’s Hospital. Credit: Google Maps

By optimizing its EHR’s advanced clinical documentation technology for treating rheumatoid arthritis patients, Phoenix Children’s enhanced care and physician productivity while also saving about $1 million dollars.

Documentation for Juvenile Idiopathic Arthritis is challenging because of the complexity of this chronic relapsing disease that causes disabling joint inflammation and potential for permanent joint damage and deformity, said Vinay Vaidya, MD, vice president and chief medical information officer at Phoenix Children’s Hospital.

“When we were rolling out our ambulatory EHR four years ago, we made a focused effort to design our templates to be disease-specific,” Vaidya explained. “We ensured that the key disease measures were captured at the outset, so that this data would be easily accessible for analytics, decision support and chronic disease management.”

Staff realized the need for technology that would help clinicians capture the essential information quickly and efficiently, without too many clicks or slowing clinicians. The organization turned to vendor Medicomp because of its system allowed staff to create specific disease templates, Vaidya said.

“We’ve been able to design templates that help us track quality measures and monitor patient outcomes, yet don’t require the clinicians to spend more time documenting,” he added.

Clinical documentation is key in a robust health IT set-up. It can be accomplished in most electronic health record systems, from vendors that include Allscripts, athenahealth, Cerner, drchrono, eClinicalWorks and Epic.

Without specialty or disease-specific templates, a good portion of Phoenix Children’s clinical documentation would have to be captured manually or transcribed and stored as free text. Although technologies like natural language processing can extract clinically relevant information from free text, non-structured documentation is often missing some of the key measures required to consistently track disease and compare outcomes across institutions.

“We’ve been able to design templates that help us track quality measures and monitor patient outcomes, yet don’t require the clinicians to spend more time documenting.”

inay Vaidya, MD, Phoenix Children’s Hospital

The ability to store documentation in a structured and coded format has allowed staff to use clinical data to create disease-specific dashboards. The dashboards help with chronic disease management efforts and allow clinicians to produce a longitudinal view of the patient’s disease activity. They provide at-a-glance insights regarding disease control versus disease progression, reveal what follow-up actions need to be done, and help track compliance and missed visits.

“We’re able to take the data from the dashboards and slice and dice it to answer certain specific questions, such as identifying which patients currently have inflamed joints and which don’t,” Vaidya said. “It also helps us better understand what to anticipate for patient visits and ensures that the actual visits go more smoothly for the clinicians, patients and their families.”

Before these tools, it would have been impossible to readily access much of the information clinicians now use on a daily basis to improve patient care, he added.

An additional benefit of the documentation tools is that it has improved the quality of notes, yet has not required the clinicians to spend more time documenting, Vaidya said.

“Our rheumatologists are completing 86 percent of their notes by 5 p.m. on the date of service and another 10 percent the following day,” he said. “We’ve reduced the documentation burdens for our physicians while also capturing quality measures 99 percent of the time.”

On top of all of this, Phoenix Children’s was able to save $1 million annually by virtually eliminating transcription costs in its ambulatory clinics. Clinicians can simply type in a particular disease state and the system builds 85 percent of the template for them, Vaidya explained.

“Physicians no longer dictate their chart notes,” he said.

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