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. 2021 Oct;12(5):1120-1134.
doi: 10.1055/s-0041-1740256. Epub 2021 Dec 22.

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

Jacqueline M Soegaard Ballester  1 , Geoffrey D Bass  2 , Richard Urbani  3 , Glenn Fala  3 , Rutvij Patel  3 , Damien Leri  4 , Jackson M Steinkamp  5 , Joshua L Denson  6 , Roy Rosin  4   7 , Srinath Adusumalli  8 , Clarence William Hanson  9   10 , Ross Koppel  7   11   12   13 , Subha Airan-Javia  14   15
Affiliations

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

Jacqueline M Soegaard Ballester et al. Appl Clin Inform. 2021 Oct.

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.

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Conflict of interest statement

The application described in this manuscript was designed, developed, and implemented by an internal group of clinicians and clinical application developers at Penn Medicine. There were no outside funds used to design, build, implement, or study the application as described in this manuscript. In 2018—after the design, development, and implementation of this application described in the manuscript—the project leader and the last author of the paper, Dr. Subha Airan-Javia, and the Penn Center for Innovation launched a start-up company to bring the application into other health systems (TrekIT Health Inc. d/b/a CareAlign). Both Dr. Airan-Javia and the Board of Trustees of the University of Pennsylvania own equity in the company and receive royalty payments on an annual basis from sales of the company. Dr. Airan-Javia is a full-time salaried employee and CEO of the company, as well as a member of the Board of Directors. No other authors have any involvement in this company, financial or otherwise. The other authors declare that they have no conflicts of interest related to this work. Dr. Airan-Javia reports no salary from TrekIT Health Inc. during the conduct of the study; but as stated above, has received salary from TrekIT Health Inc. outside the submitted work.

Figures

Fig. 1
Fig. 1
Optimized for mobile and desktop viewing. Carelign adapts to device form-factor while maintaining intuitive displays of data and care plan information.
Fig. 2
Fig. 2
The Carelign care plan. Carelign utilizes modular, semi-structured elements for user-generated problems and the plan elements and tasks contained within them.
Fig. 3
Fig. 3
Usage over time. Panel ( A ) shows total unique weekly users over time and panel ( B ) shows total unique weekly sessions over time, both broken down by user discipline. Note that users and sessions decreased each year in December, likely due to reduced elective admissions around United States holidays. Likewise, users and sessions decreased from March to May 2020 given efforts to decrease nonessential inpatient admissions during the COVID-19 pandemic. Note: Due to an error in data collection, login sessions for the following date range were omitted from panel (B): 11/19/2017–1/20/2018.
Fig. 4
Fig. 4
Access method over time. Most users access Carelign by launching it from within the electronic health record.
Fig. 5
Fig. 5
Communication and task management. Panel ( A ) shows the number of times per week that users used Carelign to view care team information or generate phone calls from within Carelign. This decreased since the implementation of EpicCare Inpatient in 2017 but has remained steady since. Panel ( B ) shows the number of times per week that users added or edited tasks within Carelign. These numbers have remained steady since implementation (except for the months corresponding to the first Spring 2020 surge of the COVID-19 pandemic). Note: Due to errors in data collection, login sessions for the following date range were omitted from panel (A) (05/24/2016–06/04/2016, 09/10/2017–11/04/2017, 12/17/2017–12/23/2017, and 01/13/2019–04/13/2019) and panel (B) (05/24/2016–06/04/2016, 12/17/2017–12/23/2017, and 01/13/2019–04/13/2019).
Fig. 6
Fig. 6
User perceptions of Carelign on 2016 Survey. Out of 760 user respondents, 598 responded to statements assessing their opinions on the impact of Carelign on different aspects of their workflow efficiency, effectiveness, and satisfaction. Users rated their agreement with the seven statements on a 5-point Likert scale.
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