Evaluation of digital health tool implementations
One to One Versus Team-Based Communication Among Care Providers in UCSF’s Intensive Care Nursery
Collaborating with the UCSF Center for Digital Health Innovation and clinical care team members, this project evaluates the impact of Voalte Story, a care team based communications and messaging platform used by care providers in the Intensive Care Nursery (ICN) of Benioff Children’s Hospital. The goal of this collaboration is to understand whether a team-based messaging system improves communications and efficiencies in care settings where multiple disciplines and provider types are involved in patient care. This pragmatic evaluation will help researchers understand communications preferences among ICN care providers, and will help clinical leaders determine the optimal tools for internal clinical communications.
The Impact of Transitioning from Availability of Outside Records within EHR to Integration of Local and Outside Records within EHR
Substantial effort over the past decade has resulted in greater electronic availability of outside records for frontline clinicians. However, most approaches to enabling such availability require clinicians to go outside of their local EHR (e.g., by logging in to a community longitudinal record) or to go to a separate tab in their local EHR that houses outside records. Under either approach, clinician workflow is interrupted and cognitive effort is required to marry local EHR data with data available in outside records. Newer approaches seek to comingle local EHR data with data from outside records, such that clinicians stay within their workflow and are presented with an integrated list of encounters, lab results, problems, medications, etc. Given the substantial work required to achieve this “last mile” step of integrating data from local and outside records, it is critical to assess the impact of such integration. We therefore undertook the first-ever study to specifically investigate whether the frequency of outside record viewing increases after such integration as well as characterize for which types of encounters, viewers, and patients any increases accrued.
Ask About What Matters: A Bundled Intervention to Improve Accessible Advance Care Planning
Building on previous literature about the challenges of documentation and the importance of care continuity in advance care planning discussions in the hospital setting, UCSF adopted a centralized and easily accessible location within the EHR for all ACP activities – the Advance Care Planning Navigator. Novel EHR based tools for ACP documentation were deployed and an initiative was launched to increase awareness and use of these tools along with the ACP Navigator to promote accessible ACP documentation. EHR audit log data was used to capture EHR users’ granular interactions within the medical record, and allowed us to measure Navigator access. The rates of ACP Navigator entry for those with ACP documentation did significantly increase during the intervention period for physicians and nurses, likely driven by increased visibility of documentation within the banner which allowed for direct access into the Navigator with a single click.