Joan Hicks, CIO of UAB Health System (photo taken prior to COVID-19 pandemic)Over the past year, the electronic health record (EHR) has undergone many changes to increase the wellness of its users. 2020 has brought many new challenges and demands on clinicians’ time and how they work. To reduce stress, UAB teams have collaboratively been working on streamlining EHR demands for users.
This summer, the UAB Medicine Office of Wellness issued a survey to all EHR users—physicians, APPS, nurses, trainees, and staff—to provide feedback about changes they would like to see or report issues they may have had in the past. The UAB Medicine Office of Wellness encouraged users to speak up about their needs to make the process more efficient for all. There were a total of 181 responses and 400 comments in this summer’s survey. After the survey closed, the office turned it over to HSIS, who reviewed every single request. HSIS not only worked to remedy the requested issues, but were also willing to meet with users in a one-on-one setting when necessary. For those who submitted their name with the requested changes, HSIS reached out in a personal way to help guide the user and meet their needs.
Below is a list of EHR changes that have been made in the past year—requests that stemmed from both the UAB Medicine Office of Wellness survey and the HSIS website request form.
Winter 2020
Early this year, the Sanford Guide was integrated into the electronic health record. The electronic version of this nationally-respected guide was integrated into IMPACT to provide faster access to evidence-based recommendations for appropriate antimicrobial therapy.
Spring 2020
In the spring of 2020, HSIS teams enabled remote patient monitoring capabilities to facilitate care within the patient’s home by monitoring of blood pressure, weight, and glucose. Moreover, a number of changes were made to help offset stress produced by the COVID-19 pandemic. The HSIS application development team created a custom Infectious Disease view which combines temperature curves, culture and other key lab results with a timeline of antibiotics received by the patient. This facilitates evaluation of a patient's possible infectious diseases, highlighting important results and displaying the current regimen being used to treat them. Further, COVID-19 related enhancements included: creating and updating COVID-19 lab orders to support the dynamic nature of testing, implementing standardized COVID-19 discharge instructions as developed with infection control and physicians, adding triggers on tracking boards in the Emergency Room and Women’s services areas for COVID-19 results, new alerts to notify clinic providers and staff when a patient has recently tested positive for COVID-19 or Influenza, new documentation templates to account for COVID-19 communications, and clinical decision support to make it easier for providers to adhere to UAB testing policy and reporting required by the county health department.
Summer 2020
In the summer of 2020, a new method of notification was added for the COVID-19 Convalesced Order, called SmartZone. HSIS teams enabled the ability for patients to attach documents to portal messages for ease of communication between patients and providers. Portal Attachments are meant to streamline data sharing and accelerate quality patient care. ED Launchpoint, Cerner’s enhanced emergency department tracking board, helps emergency physicians by providing more patient data face up, enabling faster clinical data. The EMedicine Code Stroke order was added and now activates the American Well cart for code stroke. Another helpful update in the electronic health record is the Benzodiazepine calculator, which calculates and displays the total daily lorazepam milligram equivalents (LME) for all of the prescription benzodiazepines a patient is taking as an outpatient, and it provides a direct link to the patient's controlled substance report. This feature eliminates the time-consuming process of calculating LMEs required to comply with Alabama Board of Medical Examiners prescribing rules. Last, the HSIS Web Development team created a custom component for IMPACT that provides an enhanced view of patients past and future UAB clinic appointments. This custom component for Appointment View replaces the Cerner standard with an improved view that minimizes scrolling, listing the clinics' full names instead of their non-intuitive 3-letter codes. The change makes it easier for a UAB provider to determine where within the health system a patient has been seen or is scheduled to be seen.
Fall 2020
This fall, even more changes took place, as the HSIS team continues to work diligently to remedy stressors. HSIS worked with the transplant physicians and administrative leadership to develop a custom mobile app, the Transplant Referral App, which gives referring physicians 24/7 access to the UAB Comprehensive Transplant Institute (CTI) team. It includes quick references to selection criteria and secure access to patient records, plus contact information for all CTI doctors and surgeons. A built-in form allows physicians to easily start the referral process from their iOS or Android device. Fusion Enhancements, another custom mobile app developed by HSIS several years ago, was updated for ease of access to certain patient data from IMPACT. In October 2020, the team made multiple changes to improve usability of existing features and also integrated Dragon speech recognition to facilitate the creation of simple provider notes from the Fusion app.
Ongoing
Several changes are still underway for the electronic health record. Electronic Consult Orders are being implemented by hospital service line for electronic notifications. Documentation changes are being made to ease navigation and support telehealth visits and specific specialty requirements. The Core Work Manager, a new rounding platform that provides each specialty with a summary view of the patient data they need for rounding and provider handoffs, started in December of 2019 and is still being implemented by service lines. HSIS staff also developed the coding required to integrate UAB Connect with Core to provide seamless paging from the Work Manager view.
EHR users can continue to make requests related the health record on HSIS’s website. The UAB Medicine Office of Wellness will continue to offer a yearly survey, as they have done the past two years. Moreover, trainings for the EHR are being developed by HSIS and will be offered some time in 2021.