Reducing Order Friction in Pediatric EHR Systems: A Quality Improvement Initiative

Presentation Time: 05:00 PM - 06:30 PM

Abstract Keywords: Pediatrics, Workflow, Qualitative Methods
Primary Track: Applications
Programmatic Theme: Clinical Informatics

Efficient electronic health record (EHR) systems are critical for optimizing workflow and ensuring patient safety. However, many EHR systems are plagued with inefficiencies and excessive alerts. Order friction (OF) is an EHR vendor-derived metric describing how difficult it is for clinicians to enter orders, and includes the sum of all interruptive alerts, procedure duplicate checks, medication warnings, and changed fields within the order composer. Preliminary data shows high OF correlates with increased clinician stress, burnout, and delays in patient care. We devised a framework to prioritize order optimization. We focused on total order changes, or how many times a user changes a default, to prioritize orders with most OF and most volume. Oral solutions comprised most of the top medications, as pediatric care relies on weight-based dosing. We streamlined the order process for acetaminophen and ibuprofen oral solutions, reducing the previous requirement of four clicks for every-six-hour dosing as needed to zero clicks or CPO. Our data also reveals that the friction of preference lists is greater than the friction for order sets. User configured preference lists and order sets further reduced OF. In specific department preference lists, order design can be improved by setting default values for commonly used settings, thereby reducing the number of clicks and adjustments required to complete an order. The next steps are to focus on preference list orders and departments with the highest OF scores. We aim for an impactful reduction in clinician burden and improvement in patient care efficiency.

Speaker(s):
Bayley Bennett, MD
Emory University

Author(s):
Brittany Brennan, MSN, PNP-AC - CHOA; Julia Yarahuan, MD, MBI - Children's Healthcare of Atlanta/Emory University; Swaminathan Kandaswamy, PhD - Emory University School of Medicine; Sarah Thompson, MSHIMI, BSN, RN - Children's Healthcare of Atlanta; Vedant Gupta, DO - Emory University/Children's Healthcare of Atlanta; Courtney Byrd, MD - Emory University/Children's Healthcare of Atlanta; Sunita Hemani, MD - Emory University/Children's Healthcare of Atlanta; Gargi Mukherjee, MD - Emory University/Children's Healthcare of Atlanta; Ryosuke Takei, MD - Children's Healthcare of Atlanta; Colin Packard, MD - Children's Healthcare of Atlanta; Bayley Bennett, MD - Emory University;