At Phoenix Children’s, A Clinical Documentation Initiative is Driving Results

This article originally appeared on Healthcare Informatics and was written by Heather Landi.

any healthcare provider organizations strive to improve the quality of documentation to enhance quality measure reporting and better track patient outcomes, a key step for successful chronic disease management. Documenting specific details about a patient’s condition during the patient visit enables a physician to see a clearer picture of the patient’s disease progression.

However, with complicated diseases, such as juvenile idiopathic arthritis, it can be challenging for physicians to drill down and capture specific details and document other measures all during a 20-minute patient visit. What’s more, many physicians

At Phoenix Children’s Hospital, clinical and IT leaders worked closely on an initiative to leverage technology to efficiently capture disease-specific details, which enables physicians to use structured documentation in real-time at the point of care. Vinay Vaidya, M.D., vice president and chief medical information officer (CMIO) at Phoenix Children’s, notes that delivering actionable, relevant clinical information to clinicians at the point of care is an ongoing challenge, especially with regard to complex clinical sub-specialties. For example, with pediatric asthma patients, physicians need to know whether the patient is taking his or her inhaler or has been to the emergency department, while when treating a patient with rheumatoid arthritis, providers want to know whether the patient has had an eye exam as eye problems can be a complication associated with RA, Vaidya explains.

Four years ago, Phoenix Children’s began rolling out an electronic health record (EHR) across the network’s ambulatory clinics, and clinical leaders recognized an opportunity to advance how clinical data is captured at the point of care to deliver actionable information to clinicians. Working with health IT vendor Medicomp Systems, clinical and IT leaders at Phoenix Children’s collaborated to implement a clinical documentation technology solution across the network’s outpatient clinics.

 

Vinay Vaidya, M.D.

“We were starting our ambulatory journey and we were being forward thinking—what is the best way to capture the data electronically so that it meets everybody’s needs” Vaidya says.

Phoenix Children’s is a pediatric health network providing pediatric inpatient, outpatient, urgent care, emergency and trauma services and offers care in more than 75 subspecialty fields of pediatric medicine. Phoenix Children’s Hospital is a 433-bed hospital and the organization has more than 1,000 physician members providing services to patients throughout the Phoenix area and Southern Arizona.

As a first step in this initiative, physicians in the pediatric rheumatology division worked closely with the IT team to create templates that capture disease-specific details on patients with juvenile idiopathic arthritis (JIA), especially hard to track metrics. That data then goes to a data warehouse and is fed to Phoenix Children’s-created dashboards that are accessible to the clinical team.

Michael Shishov, M.D., one of Phoenix Children’s three pediatric rheumatologists who collaborated with Vaidya to spearhead these efforts, notes that these disease-specific details, which are now being captured for the first time, provides valuable information to physicians during patient visits. “Juvenile idiopathic arthritis is a complicated disease to document because we must capture details on 71 individual joints as well as a number of other measures. However, in collaboration with IT, we have developed an elegant template that enables efficient documentation of the joint exam as well as key quality metrics, including clinical inactive disease in juvenile idiopathic arthritis,” Shishov says.

“We have been able to build these templates very quickly,” Vaidya says. “We also are building in clinical decision support tools and alerts to help enhance care. There is an auto calculation tool which enables the clinicians to do their jobs faster. What we were doing is setting the groundwork for capturing that data in the right way, right at the beginning, and yet, make it easy,” he says, noting that many physicians are dissatisfied with the burden of documentation and quality reporting. “We knew that if we did that, the next step would follow, and we would be able to harness this data from a single patient and take it to a population level.”

He adds, “We do feel that we have been able to use this technology to build disease-specific templates very rapidly, and yet not unduly burden physicians while capturing quality data that is driving many of our real-time dashboards,” Vaidya says.

Clinical and IT leaders have rolled out the technology across 30 specialty divisions, focusing on building disease-specific templates for four or five of the most common diseases within those specialties. The technology tool helps to create higher quality documentation that drives improvements in patient care, Vaidya says, as physicians have access to structured documentation that brings real value back to them and their patients in near real-time. “We’ve been able to customize documentation templates based on not only the unique needs of each specialty but also the most common specific diseases within each pediatric specialty. This helps us to track quality measures and monitor patient outcomes which is a key requirement for successful chronic disease management,” he says.

One of the key benefits of the technology tool is that physicians can access the dashboard prior to a patient’s appointment, which has enabled more efficient pre-visit planning. Two weeks prior to a patient’s appointment, the clinical team gathers and discusses each patient to make a complete plan. Vaidya says the dashboard provides a visualization of the patient data to give clinicians a complete snapshot of the patient and the status of the patient’s particular condition.

“For a patient with juvenile idiopathic arthritis, the dashboard will show that this patient has come in multiple times and it also indicates that the joint disease at that particular visit has completely resolved; it was quiet and there was no inflammation. Because this is a typical relapsing disease, it is important that this tool gives you, at a glance, a view of how the disease is flaring up and then going down, how many joints are involved, and the score given by parents and the physician. It is showing a very clear-cut picture of the disease trajectory. At a glance, the physicians can see how a patient is progressing, what needs to be done, and other critical aspects that are gaps in care,” Vaidya says.

According to Vaidya, the use of the technology solution has increased clinician productivity and enhanced the quality of documentation. In addition, Phoenix Children’s has virtually eliminated transcription in its ambulatory clinics, saving the organization over $1 million dollars annually on transcription costs. “Prior to this, all of our documentation was done through dictation, and that was a significant volume of work. Now, the majority of our notes are structured, coded, electronic data, and that has done away with dictation,” Vaidya says.