Appl Clin Inform 2016; 07(03): 790-802
DOI: 10.4338/ACI-2015-11-RA-0164
Research Article
Schattauer GmbH

The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

Raj Mehta
1  University of Florida - Hospital Medicine, Gainesville, Florida, U.S.A.
,
Nila S. Radhakrishnan
1  University of Florida - Hospital Medicine, Gainesville, Florida, U.S.A.
,
Carrie D. Warring
2  University of Florida - Medicine, Gainesville, Florida, U.S.A.
,
Ankur Jain
1  University of Florida - Hospital Medicine, Gainesville, Florida, U.S.A.
,
Jorge Fuentes
2  University of Florida - Medicine, Gainesville, Florida, U.S.A.
,
Angela Dolganiuc
3  University of Florida - Gastroenterology, Hepatology, and Nutrition, Gainesville, Florida, U.S.A.
,
Laura S. Lourdes
4  Indiana University - Hematology/Oncology, Indianapolis, Indiana, U.S.A
,
John Busigin
5  University of Tennessee-Knoxville - Family Medicine, Knoxville, Tennessee, U.S.A.
,
Robert R. Leverence
6  University of Florida - Medicine/Hospital Medicine, Gainesville, Florida, U.S.A
› Author Affiliations
Funding Source This work was supported by the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine.
Further Information

Publication History

received: 02 March 2016

accepted: 30 May 2016

Publication Date:
19 December 2017 (online)

Summary

Background

The integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.

Objective

We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.

Methods

This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.

Results

Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].

Conclusion

Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation.

Citation: Mehta R, Radhakrishnan NS, Warring CD, Jain A, Fuentes J, Dolganiuc A, Lourdes LS, Busigin J, Leverence RR. The use of evidence-based, problemoriented templates as a clinical decision support in an inpatient electronic health record system.