1. Study Design: Pre/Post Quality Improvement A Digital Dilemma: Improving EMR Documentation in Well-Child Visits Sabrina Silver, DO; Stephanie Reiser, DO; Kevin Sisk, DO; Rebecca Englebretson, DO; TJ Coker, MD Family Medicine Residency, University of Nebraska Medical Center, Omaha, NE 68198 and Offutt AFB Analysis ResultsConclusions and Future Directions Introduction Study Design: Pre/Post Quality Improvement Methods Three Plan, Do, Study, Act (PDSA) cycles, each followed by chart review to assess for the following components: Growth Curve (GC) Ages & Stages Questionnaire (ASQ) Newborn Screening (NS) Birth History (BH) Handout Given (HG) Components chosen based on AAP Bright Futures Preventive Pediatric Health Care recommendations 2 Conclusions: Educating technicians on how to copy forward and chart tracked components using the PDSA model can improve charting, without increasing physician workload The gap created by non-communicating EHRs can be improved upon with an awareness of essential chart components Clarifying documentation standards and responsibility of providers vs. technicians leads to more complete charting Further areas of study Standardized checklists for infrequent encounter types Delegate central clinic personnel to obtain outside records The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force. Special thank you to Dr. Jestin Carlson, MD for his help with statistical analysis. Acknowledgement References Chi-Squared Odds Ratio Componentp-value GC0.03 ASQ<0.01 NS<0.01 BH0.01 HG0.20 ComponentOR (95% CI)p-value GC3.89 (1.06-14.29)0.04 ASQ5.78 (2.87-11.67)<0.01 NS2.48 (1.52-4.03)<0.01 BH1.76 (1.11-2.79)0.02 HG1.5 (0.96-2.38)0.08 1.Hagan JF, Shaw JS, Duncan P, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Pocket Guide. Elk Grove Village, IL: American Academy of Pediatrics. 2.Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009. 3.Speroff, Theodore, and Gerald T. O ʼ connor. "Study Designs for PDSA Quality Improvement Research." Quality Management in Health Care 13.1 (2004): 17-32. Armed Forces Health Longitudinal Technology Application (AHLTA) = EMR in use at this military outpatient facility Contains built-in workflows for documenting well-child visits Incorporates the preventive health measures recommended by the AAP 1 Hurdles to consistent documentation identified at this military family medicine residency program: Lack of communication with EMR at civilian birth facility requires transference of newborn patient information from hospital chart to outpatient clinic Key birth history components must be manually entered or carried forward each clinic visit Lack of awareness of charting standards and responsibilities among technicians and providers Infrequent occurrence of these visits in the clinic Objective Interpretation for GC component: chi-squared shows change between cycles was significant. Change occurred with the intervention and GC was 3.89 times more likely to be charted correctly after the training. PDSA Cycles 3,4 Training provided to half of clinic to improve clinical documentation Develop a workflow with the EMR to improve availability of newborn preventive metrics at routine visits. AIM Statement: Utilize the PDSA model to increase documentation of 5 different components to >50 % in 1 year. Final Review with Goal of 50% met Age (m)Cycle 1Cycle 2Cycle 3 0042 0.5162 242311 461316 691511 934 12700 Total306553 Number of Charts by Age Peer-reviewed 30 randomized 0-12 month well-child visits to establish baseline Trained entire clinic, reassigned all components to technicians