Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Implementation of an Electronic Interface for Medical Record Documentation in an Academic Pediatric Rheumatology Outpatient Clinic.

Woo2,  Jennifer M. P., Parsa2,  Miriam F., Amarilyo2,  Gil, Afsarmanesh1,  Nasim, Gallagher2,  Kerry T., Rullo2,  Ornella J., McCurdy2,  Deborah K.

Division of Internal Medicine and Neurosurgery-Medicine; Hospital Medicine and Neurosurgical Clinical Quality Programs, UCLA, Los Angeles, CA
Division of Pediatric Rheumatology, UCLA, Los Angeles, CA

Background:

Health information technology (HIT) has gained importance in clinical practice in an effort to improve clinic efficiency and to minimize medical and communication errors resulting from handwritten notes. Our healthcare center utilizes an electronic medical record (EMR) system that requires outpatient clinic physicians to document patient visits on paper clinical notes (PCN) and send them outside the department to be uploaded. This process generates a lag period, ranging from 2 to 14 days when PCN are inaccessible via network computer. In response, we have designed, created, and implemented an EMR interface or electronic note (EMRI) that mimics the paper template, allowing the physician use a portable tablet computer in the exam room to directly upload their findings to an established clinical document system (CDS) and the EMR. We are assessing patient perception of the use of an EMRI in clinic and evaluating its effects on the workflow of the pediatric rheumatology outpatient clinics.

Methods:

Our EMRI is a Microsoft Excel form and includes measures to verify medication dosing based on body surface area and weight, to maximize billing criteria, and to facilitate retrieval of clinical data for future research. Patients or their parents were asked, via paper survey, to anonymously assess the quality of care and their perception of EMRI use in clinic; we will continue these observations until our EMRI is fully integrated into clinical practice. Clinic efficiency was evaluated by monitoring the length of time physicians spent with each patient, the additional time dedicated to charting following the patient visit, and the time required for the clinical notes to be uploaded to the EMR.

Results:

With the implementation of our EMRI, we have reduced the average time required to upload clinical documents by 6 days and increased the average percentage of notes uploaded within 48 hours of the patient visit by 75% (p < 0.0001). Currently, 93% of patients/parents surveyed (n = 25) were receptive to the use of a clinical EMRI and 75% believed that an EMRI would benefit the patient's quality of care. There was no significant difference in perceived satisfaction in visit length or quality of care between visits documented with EMRI compared with those documented using PCN. On average, rheumatologists spent 38 minutes with each patient when using PCN, comprising about 40% of the clinic visit. Patients generally spent the majority of the remaining 60% of their visit waiting to be roomed or to be seen by the rheumatologists. These PCN times will be compared with EMRI times to assess improvement in clinic workflow.

Conclusions:

Patients and their parents have indicated receptiveness to EMRI use in clinic and believe that it would benefit patient care. The implementation of an EMRI can improve clinic efficiency and minimize errors resulting from handwritten notes in an academic outpatient rheumatology practice without compromising patient perception of quality of care.

To cite this abstract, please use the following information:
Woo, Jennifer M. P., Parsa, Miriam F., Amarilyo, Gil, Afsarmanesh, Nasim, Gallagher, Kerry T., Rullo, Ornella J., et al; Implementation of an Electronic Interface for Medical Record Documentation in an Academic Pediatric Rheumatology Outpatient Clinic. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :998
DOI: 10.1002/art.28765

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