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. 2022 Dec 13;30(1):8-15.
doi: 10.1093/jamia/ocac201.

Team is brain: leveraging EHR audit log data for new insights into acute care processes

Christian Rose  1 , Robert Thombley  2 , Morteza Noshad  3 , Yun Lu  4 , Heather A Clancy  4 , David Schlessinger  4 , Ron C Li  3   5 , Vincent X Liu  4 , Jonathan H Chen  3   5   6 , Julia Adler-Milstein  2
Affiliations

Team is brain: leveraging EHR audit log data for new insights into acute care processes

Christian Rose et al. J Am Med Inform Assoc. .

Abstract

Objective: To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes.

Materials and methods: We selected one widely-used process outcome: emergency department (ED)-based team time to deliver tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS). We evaluated Epic audit log data (that tracks EHR user-interactions) for 3052 AIS patients aged 18+ who received tPA after presenting to an ED at three Northern California health systems (Stanford Health Care, UCSF Health, and Kaiser Permanente Northern California). Our primary outcome was door-to-needle time (DNT) and we assessed bivariate and multivariate relationships with six audit log-derived measures of treatment team busyness and prior team experience.

Results: Prior team experience was consistently associated with shorter DNT; teams with greater prior experience specifically on AIS cases had shorter DNT (minutes) across all sites: (Site 1: -94.73, 95% CI: -129.53 to 59.92; Site 2: -80.93, 95% CI: -130.43 to 31.43; Site 3: -42.95, 95% CI: -62.73 to 23.17). Teams with greater prior experience across all types of cases also had shorter DNT at two sites: (Site 1: -6.96, 95% CI: -14.56 to 0.65; Site 2: -19.16, 95% CI: -36.15 to 2.16; Site 3: -11.07, 95% CI: -17.39 to 4.74). Team busyness was not consistently associated with DNT across study sites.

Conclusions: EHR audit log data offers a novel, scalable approach to measure key contextual factors relevant to clinical process outcomes across multiple sites. Audit log-based measures of team experience were associated with better process outcomes for AIS care, suggesting opportunities to study underlying mechanisms and improve care through deliberate training, team-building, and scheduling to maximize team experience.

Keywords: audit log; busyness; stroke; team experience; teams.

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