Clinicians at pediatric health system save charting time following ambulatory optimization

Children’s Minnesota and Oracle Health recently began a journey for primary care optimization focused on improving the areas of care coordination and clinic operations. In conjunction with the rollout of PowerChart Touch, this work effort spanned three primary care visit types which included well child, complex care management, and Ready Care (walk-in). Staff at the Minneapolis-based pediatric health system aimed to improve care for its patients by returning provider time back to the patients and away from their charts.

“We undertook the Oracle Health clinical blueprint evaluation process and identified several areas for improving work within the electronic health record (EHR),” says Chase Shutak, MD, MPH, clinical informaticist and primary care pediatrician. “Specifically, we looked at our care team model and assigned roles, chart prep and review, documentation standardization, and rooming inconsistencies.”

In addition to improving care experiences for children and their families, staff also aimed to help provide insights into healthcare disparities and clinic financials.

“After Oracle Health completed an evaluation of our processes, it identified high-yield areas for improvement in our pre-visit planning, the check-in process, rooming and intake, assessment documentation, and population health coordination,” says Shutak.

After the optimization, new workflow efficiencies helped eliminate approximately 66 hours of clinicians’ EHR time per month¹ and reduce clinicians’ after-hours time in the EHR by 16%.²

“For me, the number of clicks felt significantly reduced,” says Razaan Byrne, MD, pediatrician. “I was able to get a lot more done in the room when I was with the family, instead of having to do it outside of the room. This made it easier to finish clinic visits and notes at the end of the day.”

Clinicians improved chart navigation efficiency, reducing the number of times they switched between tabs within patient charts by 8.7%.³ Same-day encounter closures increased by 10.1%.⁴ These improvements can contribute to an improvement in discharged not final billed (DNFB) and healthier cash flow.

Furthermore, Children’s Minnesota was able to streamline its Ready Care service, by using its new Cerner ED LaunchPoint product. This gave the facility direct visibility into current visit status and actions, as well as a patient summary view with face-up, one-click-order favorites.

“ED LaunchPoint was revelatory for our urgent care providers. It is refreshingly easy to use and provides immediate feedback on time-to-doctor or overall length-of-stay,” says Shutak. “It was designed for efficient chart review and quicker evaluations.”

To further support mobility across all visit types, PowerChart Touch was rolled out while Children’s Minnesota’s primary care optimization occurred. PowerChart Touch supports provider mobility on smartphones or tablets, allowing providers to review charts, take photos for easy import, and document with built-in dictation software.

“I personally find PowerChart Touch incredibly useful for on-call pages and after-hours results follow-up, because I don’t have to tote my laptop around everywhere,” says Shutak. “One of my colleagues now documents almost exclusively via the built-in dictation software as he moves between rooms. He essentially finishes almost all of his notes outside of the room after leaving.”

Overall, the optimization project has been successful. Children’s Minnesota plans to continue using the operations, efficiency, and quality dashboards that they partnered with Oracle Health to develop. These dashboards will give staff insights into evaluating workflow and process for continuous optimization.

“We are excited to continue our relationship with Oracle Health as we further optimize our ambulatory experience, by taking advantage of Oracle Health developed clinic enhancements that are on the horizon,” says Shutak.

 

Outcomes achieved prior to Oracle acquisition of Cerner. Company name updated to reflect current organization name.

¹ Comparing adjusted time per patient from July 2021 to September 2021 to November 2021 to January 2022, after completing the primary care optimization across 24 providers, as this allowed for a 5% decrease which is on average 66 hours per month.

² Comparing after-hours time in the EHR from July 2021 to September 2021 to November 2021 to January 2022, after completing the primary care optimization across 24 providers.

³ Comparing tab hops per patient from July 2021 to September 2021 to November 2021 to January 2022 after completing the primary care optimization across 24 providers.

⁴ Comparing same-day encounter closures per patient from July 2021 to September 2021 to November 2021 to January 2022 after completing the primary care optimization across 24 providers.