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A Novel Cross-application Approach For Optimizing The Electronic Health Record To Improve Perioperative Efficiency
*Dido Franceschi, *Maritza M Suarez, *Jose Ruiz, *David Seo, Nipun Merchant
University of Miami, Miami, FL

OBJECTIVE(S): The electronic health record (EHR) has become integral to perioperative care. While most reports describe strategies improving surgery day productivity, few include perioperative interventions to improve efficiencies. We present a holistic perioperative optimization approach led by a clinical informatics (CI) team with the goal to optimize the workflow within our EHR, improve operative room (OR) metrics and user satisfaction.
METHODS: A cross-application CI team consisting of clinicians, informatics specialists and analysts spent 6 weeks assessing and optimizing users in all perioperative areas (scheduling, day of surgery, postop discharge/admission). Elbow-to-elbow retraining and simultaneous content development was performed utilizing an Agile workflow process optimization with Scrum framework. This iterative approach averaged one week from build to change implementation. Pre/post optimization surveys were sent.
RESULTS: 242 enhancements were completed in the OR. While most impacted documentation, all areas were enhanced including billing, reporting, registration, device integration, scheduling, central supply, etc. First case on time start (FCOTS) improved from <70% to >85% and total delay was halved, which are consistently sustained (Figure). While only 5% of users agreed to proficiency in the EHR system, this improved to 70% post-optimization. EHR confidence and acceptance improved from 40% to 90%.
CONCLUSIONS: To improve workflow efficiency, all who contribute to the perioperative process must be assessed. This IT driven initiative resulted in improved FCOTS, perioperative workflows, and user satisfaction.


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