When Phoenix Children's Hospital set out to improve clinical documentation in outpatient settings, it found the answer in technology.
The 433-bed hospital — one of the nation's largest children's hospitals with a medical staff of nearly 1,000 pediatric specialists — was looking for a more efficient way to document chronic diseases such as juvenile idiopathic arthritis.
Documentation for JIA, a common type of pediatric arthritis, is particularly challenging because of the complexity of the autoinflammatory disease, according to Vinay Vaidya, MD, vice president and chief medical informatics officer for Phoenix Children's. There are multiple types of JIA, including systemic, oligoarticular and polyarticular. Additionally, there are more than 70 joints in the body, which makes documentation for the disease even more complex.
Compounding the challenges associated with documenting JIA was the fact Phoenix Children's did not have specialty or disease-specific templates for documentation. Therefore, a good portion of documentation had to be done manually or transcribed or stored as free text, according to Dr. Vaidya.
"Although technologies like natural language processing can extract clinically relevant information from free text, nonstructured documentation is often missing some of the key measures required to consistently track disease and compare outcomes across institutions," he said.
The hospital knew it needed technology that would help physicians improve documentation without requiring them to spend extra time outside of work documenting.
The solution
Phoenix Children's began using Medicomp Systems' Quippe Clinical Documentation solution, which is designed to help nurses and physicians more simply complete their clinical documentation and track quality measures.
Dr. Vaidya said the solution allows physicians to easily obtain information on quality measures and patient outcomes in real time. Using documentation from the solution, Phoenix Children's was able to create dashboards that are specific to certain diseases, including JIA and diabetes. Dr. Vaidya said the dashboards, which clinicians may access during pre-visit planning sessions, help clinicians see the big picture of a patient's illness, such as care gaps and the most current disease status. They can also see what follow-up care may be necessary with an individual patient, as well as how often the patient has missed a visit to their clinician.
"We're able to take the data from the dashboards and slice and dice it to answer certain specific questions, such as identifying which patients currently have inflamed joints and which don't," said Dr. Vaidya. "We use the tool for our pre-visit planning so we can set up reminders of what needs to be done at the point of care. It also helps us better understand what to anticipate for patient visits and ensures that the actual visits go more smoothly for the clinicians, patients and their families. Before we had these tools, it would have been impossible to readily access much of the information we now use on a daily basis to improve patient care."
Since Phoenix Children's began using the Medicomp Systems' Quippe Clinical Documentation solution in 2015, the quality of clinician notes has improved, and rheumatologists are completing most of their notes (86 percent) by 5 p.m. on the date of service.
Michael Shishov, MD, a Phoenix Children's pediatric rheumatologist who collaborated with Dr. Vaidya on the clinical documentation efforts, said a complicated quality metric for JIA, called clinical inactive disease, is also successfully recorded by the providers in 99 percent of all clinical notes.
Overall, the hospital has saved $1 million annually by essentially eliminating the need for transcription.
Clinical documentation lessons for other hospitals
Dr. Vaidya recommended that other hospitals consider similar efforts to improve clinical documentation.
"Invest in technology to support physicians and collaborate with physicians to meet their needs. Creating templates for different specialties and disease states has taken much less time than expected because the templates almost build themselves — and are ready to use," he said.
Dr. Vaidya said it's also important that the technology is a positive for patient care and helps make is faster and more efficient. Additionally, he recommended taking the necessary time to improve documentation.
"You cannot take shortcuts. You cannot not capture things that are critical and essential because it's not easy to capture. You must capture what's important for the patient and the physician," he said.
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