Incorporating longitudinal pediatric patient-centered outcome measurement into the clinical workflow using a commercial electronic health record: a step toward increasing value for the patient

Abstract

Patient-centered outcomes measurement provides healthcare organizations with crucial information for increasing value for patients; however, organizations have struggled to obtain outcomes data from electronic health record (EHR) systems. This study describes how Texas Children's Hospital customized a commercial EHR system and assembled a cross-functional team to capture outcomes data using existing functionality. Prior to its installation and customization, no surgical subspecialties besides the congenital heart and transplant surgery groups conducted prospective, patient outcomes measurement, but by 2015, the outcomes of over 1300 unique patients with supracondylar fractures, cleft lip and/or palate, or voiding dysfunction had been tracked. Key factors for integrating outcomes measurement into the clinical workflow include ongoing communication between cross-functional teams composed of clinicians and technical professionals, an iterative design process, organizational commitment, and prioritizing measurement as early as possible during EHR optimization.

Keywords: Epic; electronic health records; outcomes; patient-centered outcomes measurement; value.

Figure 1:

Emergency department history and physical documentation flowsheet: supracondylar fracture patient (image printed with permissions from Texas Children’s Hospital). (A) Fields from the initial evaluation portion of the flowsheet. (B) Fields from the preoperative evaluation portion of the flowsheet. (C) Fields from the operative experience portion of the flowsheet. (D) Fields from the condition at discharge portion of the flowsheet.

Figure 2:

Form for evaluation of patient with voiding dysfunction (image printed with permissions from Texas Children’s Hospital.).

Figure 3:

Plastic and reconstructive surgery measurement form (image printed with permissions from Texas Children’s Hospital. Mallet drawing courtesy of the Department of Physiotherapy, Royal Children’s Hospital Melbourne). (A) “Hard Stop” enabled SmartForm used for initial cleft lip and palate evaluation. (B) Speech and language evaluation note template showing SmartLists bound to SmartData elements to enable future data mining. (C) Annotated image note with mineable fields used in the operating room to document key parts of the operative repair for brachial plexus injury. (D) A functional outcome scale incorporated into the EHR using a SmartForm to track functional outcomes following brachial plexus repair.