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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

Jacqueline M. Soegaard Ballester
1   Division of General Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Geoffrey D. Bass
2   Division 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
3   Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Glenn Fala
3   Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Rutvij Patel
3   Department of Information Services, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Damien Leri
4   Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Jackson M. Steinkamp
5   Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Joshua L. Denson
6   Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States
,
Roy Rosin
4   Center for Healthcare Innovation, Penn Medicine, Philadelphia, Pennsylvania, United States
7   Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Srinath Adusumalli
8   Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Clarence William Hanson
9   Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
10   Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Ross Koppel
7   Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
11   Institute of Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
12   Department of Sociology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, United States
13   Department of Biomedical informatics, University of Buffalo (SUNY), Buffalo, New York, United States
,
Subha Airan-Javia
14   Section of Hospital Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
15   Founder/CEO, CareAlign, Philadelphia, Pennsylvania, United States
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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

Author Contributions

Application conception, design, or development: Soegaard, Urbani, Fala, Patel, Leri, Rosin, Hanson, and Airan-Javia. Application implementation: Soegaard, Bass, Urbani, Patel, Leri, and Airan-Javia. Acquisition of data: Urbani, Patel, and Airan-Javia. Analysis or interpretation of data: Soegaard, Urbani, Koppel, and Airan-Javia. Drafting of manuscript: Soegaard, Steinkamp, Denson, Koppel, and Airan-Javia. Critical revision of the manuscript for important intellectual content: Soegaard, Bass, Urbani, Fala, Patel, Leri, Steinkamp, Denson, Rosin, Adusumalli, Hanson, Koppel, and Airan-Javia. Executive, administrative, technical, or material support: Urbani, Fala, Patel, Rosin, and Hanson. Study supervision: Airan-Javia.


Protection of Human and Animal Subjects

No human or animal subjects were directly involved in this project. This project was reviewed and categorized as quality improvement by the University of Pennsylvania Institutional Review Board and was therefore exempt from approval.


Supplementary Material



Publication History

Received: 27 April 2021

Accepted: 11 October 2021

Article published online:
22 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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