A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

Jacqueline M. Soegaard Ballester; Geoffrey D. Bass; Richard Urbani; Glenn Fala; Rutvij Patel; Damien Leri; Jackson M. Steinkamp; Joshua L. Denson; Roy Rosin; Srinath Adusumalli; Clarence William Hanson; Ross Koppel; Subha Airan-Javia

doi:10.1055/s-0041-1740256

Applied Clinical Informatics, Table of Contents

CC BY-NC-ND 4.0 · Appl Clin Inform 2021; 12(05): 1120-1134
DOI: 10.1055/s-0041-1740256

Research Article

A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

Authors

Jacqueline M. Soegaard Ballester

¹Division of General Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Geoffrey D. Bass

²Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Richard Urbani

³Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
Glenn Fala

³Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
Rutvij Patel

³Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
Damien Leri

⁴Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States
Jackson M. Steinkamp

⁵Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Joshua L. Denson

⁶Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States
Roy Rosin

⁴Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States

⁷Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Srinath Adusumalli

⁸Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Clarence William Hanson

⁹Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States

¹⁰Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, Pennsylvania, United States
Ross Koppel

⁷Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States

¹¹Institute of Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States

¹²Department of Sociology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States

¹³Department of Biomedical informatics, University of Buffalo (SUNY), Buffalo, New York, United States
Subha Airan-Javia

¹⁴Section of Hospital Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States

¹⁵Founder/CEO, CareAlign, Philadelphia, Pennsylvania, United States

Abstract

Background Clinical workflows require the ability to synthesize and act on existing and emerging patient information. While offering multiple benefits, in many circumstances electronic health records (EHRs) do not adequately support these needs.

Objectives We sought to design, build, and implement an EHR-connected rounding and handoff tool with real-time data that supports care plan organization and team-based care. This article first describes our process, from ideation and development through implementation; and second, the research findings of objective use, efficacy, and efficiency, along with qualitative assessments of user experience.

Methods Guided by user-centered design and Agile development methodologies, our interdisciplinary team designed and built Carelign as a responsive web application, accessible from any mobile or desktop device, that gathers and integrates data from a health care institution's information systems. Implementation and iterative improvements spanned January to July 2016. We assessed acceptance via usage metrics, user observations, time–motion studies, and user surveys.

Results By July 2016, Carelign was implemented on 152 of 169 total inpatient services across three hospitals staffing 1,616 hospital beds. Acceptance was near-immediate: in July 2016, 3,275 average unique weekly users generated 26,981 average weekly access sessions; these metrics remained steady over the following 4 years. In 2016 and 2018 surveys, users positively rated Carelign's workflow integration, support of clinical activities, and overall impact on work life.

Conclusion User-focused design, multidisciplinary development teams, and rapid iteration enabled creation, adoption, and sustained use of a patient-centered digital workflow tool that supports diverse users' and teams' evolving care plan organization needs.

Keywords

mobile application - workflows - user-centered design - handoffs

Full Text

References

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