Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Implementation of An Electronic Interface for Medical Record Documentation in An Academic Pediatric Rheumatology Outpatient Clinic: An 18-Month Update.

Woo1,  Jennifer M.P., Parsa1,  Miriam F., Amarilyo1,  Gil, Afsar-manesh1,  Nasim, Rullo2,  Ornella J., McCurdy2,  Deborah K.

University of California, Los Angeles, Los Angeles, CA
Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA


The transition to electronic medical records (EMR) from traditional paper clinic notes (PCN) reflects a nationwide effort to improve clinic efficiency, to standardize best practices, and to ensure that critical disease processes are documented. Commercial EMR platforms are designed to universalize medical records within a healthcare network; however, they may take years to be fully implemented at large sites and are not always designed to fully capture the specific elements that characterize subspecialty clinic exams. Our healthcare center currently utilizes a transitional EMR that requires physicians to document patient visits with PCN, which are then uploaded to the center-wide EMR by a central department. This process generates a lag period of up to 3 weeks, during which PCN are inaccessible electronically. In response, we created an EMR interface (EMRI) or electronic note. Its implementation in our outpatient pediatric rheumatology clinics began in June 2010 and allows physicians to document and upload their findings directly to the patient's center-wide EMR via laptop or computer in the exam room. Objective: To evaluate clinic workflow and to assess patient perceptions as we transition from PCN to a complete EMR system.


Our EMRI is a Microsoft Excel form with VBA macros, enabling physicians to compile an accurate measure of the patient's present health. Clinic efficiency is evaluated by monitoring the length of: 1) patient-physician interactions, 2) patient wait time, 3) time dedicated to follow-up charting, and 4) time required for clinic notes to be uploaded to the EMR. Patients or their parents are asked, via paper and/or internet survey, to anonymously assess the quality of care in clinic and their perception of EMRI use throughout the transition process. Data is collected and assessed in 6 month blocks (Block 1: months 1–6; Block 2: months 7–12; and Block 3: months 13–18) and will continue until our EMRI is fully integrated into clinical practice.


One year has elapsed since the implementation of our EMRI, and approximately 56% of our weekly clinic notes are documented electronically. On average, EMRI notes become available within 12 hours of the clinic visit, whereas PCN notes require approximately 7 days (p < 0.0001). Compared to early PCN data, EMRI-use during block 2 significantly lessened patient wait time (48 vs. 23 min.; p = 0.001) and clinic visit length (85 vs. 51 min.; p < 0.0001). Patient-physician interaction time has continued to comprise approximately 50% of clinic visit duration. Of patients and parents surveyed during block 1 or 2 (n = 31; n = 43), 93% of both groups were receptive to the use of a clinical EMRI. In addition, 81% of patients/parents surveyed during block 2 believed that an EMRI would benefit the patient's quality of care compared to 67% of patients/parents surveyed during block 1 (p = 0.1).


The transition from PCN to EMRI notes can be tenuous, albeit necessary. Our preliminary data suggests EMRIs specific for targeted assessments (e.g. rheumatological evaluation) can improve medical documentation while increasing clinic efficiency, patient-physician interactions, and patient perception of quality of care.

To cite this abstract, please use the following information:
Woo, Jennifer M.P., Parsa, Miriam F., Amarilyo, Gil, Afsar-manesh, Nasim, Rullo, Ornella J., McCurdy, Deborah K.; Implementation of An Electronic Interface for Medical Record Documentation in An Academic Pediatric Rheumatology Outpatient Clinic: An 18-Month Update. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2076

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