Substantial effort over the past decade has resulted in greater health system connectivity by enabling electronic availability of outside records for frontline clinicians. However, most approaches to enabling such availability require clinicians to go outside of their standard workflow. Within Apex, clinicians must go to a separate tab that houses outside records, interrupting workflow and requiring additional cognitive effort to interpret local EHR data together with data available in outside records. Newer approaches seek to comingle local EHR data with data from outside records, such that clinicians stay within their workflow and are presented with an integrated list of encounters, lab results, problems, medications, etc. Given the substantial work required to achieve this “last mile” connectivity step of integrating data from local and outside records, it is critical to assess the impact of such integration. We therefore undertook the first-ever study to specifically investigate whether the frequency of outside record viewing increases after such integration as well as characterize for which types of encounters, viewers, and patients any increases accrued.
On July 11, 2018 UCSF Health turned on a new feature that enhanced connectivity by creating a single, integrated list of local (from UCSF Health) and external (from any other Epic-based health system) encounters presented in the Chart Review (CR) tab. Prior to this switch, outside records were only available through the CareEverywhere (CE) tab, a section of the EHR exclusive to outside records. The new feature was supplementary, such that there was no change to user ability to view outside records via the CareEverywhere tab. We studied the impact of this change on patterns of frontline clinician viewing of outside records. Our presentation will describe the results - which reflected a dramatic increase in outside record views that was true across user types (attendings, residents, nurses) and encounter types. We also find a relationship with clinical outcomes including lower length-of-stay and likelihood of imaging, suggesting that the increased viewing of outside records improved patient care.
Slides: https://ucsf.box.com/s/nl12wf9iqb2jmh9imqi9p8q5fkb6k0yn (MyAccess login required)
None required; basic familiarly with Apex useful
Dr. Adler-Milstein leads the UCSF Center for Clinical Informatics and Improvement Research and is a widely recognized clinical informatics researcher with substantial experience assessing the adoption, use, and impact of health information exchange solutions.