After COVID, our health system was experiencing an EMR knowledge deficit, especially relating to efficiency. Before COVID, the IT analyst and trainer teams had led three-week immersions to outpatient clinics and saw great increase to efficiency for providers. The clinical informatics team was tasked to redo the immersion without the resources of IT analysts. This poster will share how the informatics nurse led the pilots and used lean six sigma to decrease a three-week immersion to a five-day immersion/sprint with great results. The clinical informatics technology empowerment (CITE) team focuses on the patient’s interaction with staff holistically. Whatever staff member interacts with a patient was shadowed and given advice on how to be more efficient with the EMR system. This included front office staff, billers, medical assistants, and providers. Providers were given 1:1 time with EMR data recommendations for increased efficiency.

Our first CITE visit was a pilot or proof-of-concept visit to a primary care clinic and urgent care clinic. Using the PDSA cycle, we planned and coordinated what our week at the clinic would consist of with schedules and a lunch and learn. The CITE team prepared chart reviews of all of the providers and staff. The core CITE team consisted of three clinical informaticists and one informatics nurse specialist. Varying team members were EMR trainers and provider super users. We spent five days at the clinic, with a lunch-and-learn session on a Wednesday in which we went over standards of care with the medical assistants. The first clinic was a success, with increasing efficiency of providers and increasing patient appointments for the providers.

After three successful clinics visits, an inpatient unit and an ED was attempted with a CITE visit. We will address the deficits found when applying outpatient CITE visits to inpatient.

While using lean six sigma principles, the outpatient CITE team was able to shorten the immersion from five days to four days and remove virtual analyst support and EMR trainers available at the clinic. Outpatient clinic CITE team visits continued to be successful and increased efficiency of the providers and staff.

Common efficiency roadblocks found at clinics included issues with communication of staff, wrong workarounds taught, newer upgrades focused on efficiency that were not adopted, new graduates with limited training, and excessive paperwork flow that did not need to be used.

Provider data will be shown with a three-month analysis of before and after CITE team visit to clinic. Lessons learned will be addressed along with changes in our work at the clinics and the challenges/ differences of immersions/sprints at a primary care office versus specialty offices.

Nicole Hill MSN, RN, NI-BC, CEN

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