Focus

A smart clinician-designed, tailored chart review tool to reduce the burden of chart prep

Opportunity

The electronic health record (EHR) is repeatedly cited as a national driver of administrative burden and burnout.  

In 2018, in partnership with the EHR Transformation Team, Information Services, and the Office of the Chief Medical Information Officer, we launched a Your Big Idea Innovation Tournament to crowdsource EHR pain points and solution suggestions from Penn Medicine's frontline staff. More than 30 percent of participants described pain points related to documentation and data aggregation in the EHR.

That same year, the Department of Medicine's annual climate survey revealed "excessive Epic burden" as a significant issue across all divisions. In interviews with clinicians, it became evident that gathering the necessary clinical data to prepare for patient visits (chart prep) was indeed a considerable burden. Individuals we spoke with identified information overload issues, poor usability of data, countless clicks, and excessive scrolling as contributing to their cognitive load.

Intervention

The Focus application is one of many efforts aimed at decreasing the data aggregation burden. Working side-by-side with clinical champions from the Division of Rheumatology, we designed and developed a specialty-specific tailored view of clinical data that makes chart prep more efficient.

Focus streamlines chart review by pulling relevant information into a single view, reducing the number of clicks needed for clinicians to find information and interpret a clinical picture of the patient.

Focus enables clinicians to quickly catch up on what patients have done since their last visit, whether that be visits with other specialties, lab tests, medication changes, or new imaging studies. Smart previews of clinical notes, developed in collaboration with Penn Medicine's Data Science Team, give providers a shortcut to the assessment and plan without the need to open reports one-by-one. Telephone encounters between visits can be tagged with a dot phrase for easy access for the next visit, introducing an element of dynamic charting to reduce repetitive work in the future. 

And finally, specialty-specific data groupings for labs and medications allow providers to focus on critical information and reduce clutter.

Impact

Focus reduces the burden of chart prep for providers. 

During a two-month pilot with 18 providers in the Division of Rheumatology, Focus was utilized over 380 times, with 61 percent of users returning multiple times. Focus users required 44 percent fewer clicks to complete chart prep, and the most frequent users during the pilot demonstrated cognitive burden rating improvements by 18 points. After multiple iterations, we achieved a system usability score of 86.7. Focus received a Net Promoter Score of +34, with providers who raved, “I’m prepping my notes and using Focus! I like it quite a bit" and "Focus is open on my left monitor. Epic is open on my right. Fantastic!”  

Based on these results, Focus is currently being rolled out across multiple Department of Medicine divisions.

Phase 2: It does work
Collaborators

Erik Lang, MS
Philynn Hepschmidt, MS.Ed
Christine VanZandbergen, MPH, MS PA-C
Michael George, MD
Chadwick Johr, MD
Anupama Shahane, MD
Peter Merkel, MD
Larry Shulman, MD
Peter Gabriel, MD, MSE

Innovation leads

Katherine Choi, MD
Catherine Shi, RN, MSN
Eugene Gitelman, MD
Damien Leri, MS.Ed, MPH
Roy Rosin, MBA
Shivan Mehta, MD, MBA, MSHP

Platforms

Innovation Methods

Show me

Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.

Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.

Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.

Show me

We conducted several hours of contextual inquiry, watching providers run chart prep before ambulatory visits.

We observed providers searching and gathering the same data elements across all patients, inefficiencies such as 'fruitless' clicks due to extraneous encounter listings and inadequate filters, and volumes of telephone encounters burying the minority of actionable messages.

We also uncovered the importance of designing for trust and transparency to reduce the anxiety amongst our clinicians that they might 'miss something.'

Fake front end
Piloting a fake front end involves putting a simulated version of a product into the hands of intended users - one that doesn't yet actually perform the intended function - so that you can observe if and how it will be used in context.
 
A fake front end will help you answer the question, "What will people do with this?"
 
The first successful mobile device was created by an innovator who carried a block of wood around in his pocket to see when and why he pulled it out to pretend using it, revealing both what to build and how to build it.
Fake front end

Our earliest prototypes were simple Word documents.

We compiled the clinical data Focus would aggregate and shared it with rheumatology providers to elicit insights into exactly what was required for chart review.

We also facilitated card sorting exercises to inform subsequent digital mockups to test interactivity and user interface requirements before creating a working version of the web application.

Eye of the beholder

Ask users to wear a GoPro, keep a diary, or snap photos throughout their day. Artifacts like these will help you understand their first-person perspective.

Eye of the beholder

When the COVID-19 pandemic hit, we had to conduct research and development remotely. As we scaled the application to new divisions, we asked clinicians to share their screens while conducting chart review and note prep. The new insights we gathered from these observations enabled us to improve Focus further, making it even more efficient and automated for users.