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.

Informatics-driven implementations can be a tough sell for healthcare providers and leaders, often leaving them struggling to understand and embrace the changes. Our informatics team increased user engagement and retention of informatics concepts for both providers and leaders by implementing evidence-based practices that leveraged a combination of multimedia and in-person support.

First, we revamped our provider EHR onboarding program, slashing the original 2-day training in half. The user starts with an online journey of 12 short 10-minute modules tailored to their practice specialty. The interactive modules strategically incorporate the nationally accolated Mayer’s 12 Principles of Multimedia Learning and accommodate different learning styles, which are scientifically proven to enhance the user’s learning by aligning with their natural brain process of receiving multimedia information.

The EHR live training is the second step of the onboarding program, creating specialty-focused curricula that reiterate key points of the modules, but also demonstrate the navigation and workflow of a provider’s day within the EHR. The training allots time for questions, personalization of user settings, troubleshooting common mishaps, and review of the latest implementations by Informatics. The training is broken down into a general session plus a breakout session or two, depending on the specialty track of the user. This strategically allows for a personalized onboarding experience for the provider and the training of multiple specialties at once, ensuring a quick, yet thorough, preparation for the patient floors.

Post-live training, our users receive 30 and 60-day check-ins, presenting them with their analytics surrounding documentation and navigation of the EHR, and then providing tidbits on improving their efficiency, as applicable. The onboarding program earned the accreditation of continuing medical education (CME), in which our providers also receive credit hours toward their medical license renewals. As a result of this robust program, we have observed a remarkable shift in the quality of questions we receive, and a 25% decrease in re-education sessions across our users.

Another approach we have taken is to launch an EHR course for leaders, with the intention to increase the EHR aptitude of the team supporting the providers and reinforce the concepts learned in their training. Although we recently launched this course, we have noted a preliminary increase in EHR aptitude of 28% on average, with two users increasing their aptitude by 67%.

In-person rounds have also proven to be a valuable best practice and an immense source of support for our providers and leaders, often leading to many needed optimizations to the EHR, and empowering our users to use their voice for the betterment of their workflows.

Other best practices include creating one-page visually aesthetic flyers and producing two-minute overview videos with crisp instructional design for our larger initiatives. These are loaded onto via a QR code and quickly shared while we conduct in-person rounding on the floors.

This combination of best practices has proven to encompass a well-rounded training program, targeting the various aspects of the user’s work life, their learning styles, and the natural workflows within their practice.

Purpose: This project aimed to reduce pop-up alerts frequency and enhance alert relevance, thus minimizing alert fatigue, enhancing patient safety, improving nurse satisfaction, and optimizing workflow.

Background/significance: Alert fatigue, caused by pop-up alerts in electronic health records, poses a significant challenge for nurses, impacting workflow and care quality. To combat this problem, our team initiated a focused review of pop-up alerts to improve their efficiency and eliminate or reduce unnecessary interruptions for nursing staff.

Methods: A comprehensive review of inpatient pop-up alerts was conducted, including an assessment of the alerts most frequently triggered on nurses’ screens, the resulting actions taken by the nurse, and feedback from nurses about individual pop-ups. A subcommittee was formed, including IT analysts and the informatics team, to evaluate the necessity and relevance of each pop-up alert, implementing adjustments, improvements, or removal where appropriate. Data on pop-up firing rates and action taken were collected before and after the intervention to assess impact.

Population: The workgroup analyzed the firing frequency and subsequent action taken on the 40 existing inpatient interruptive pop-ups for nurses, focusing on the most frequently firing pop-ups to start. For the 90 days prior to making any changes, the inpatient pop-up alerts of focus fired 170,554 times.

Results: Preliminary data indicate a promising increase in action taken from pop-up triggers, with a measurable decrease in less meaningful pop-up firing rates post-implementation. A significant decrease in pop-up alerts (58.72%) was noted, 90 days post-implementation. This reduction in pop-ups and increase in action taken aligns with our project goals and underscores the potential for optimized alert systems to alleviate alert fatigue.

Conclusion: Optimizing pop-ups through targeted adjustments and adherence to best practices effectively reduces less meaningful interruptions, potentially reducing alert fatigue among nurses. This approach supports the goal of enhancing the well-being of nursing staff and patient safety by streamlining alert systems and enhancing workflow efficiency. This project is ongoing.

Purpose: To describe how the post-acute care interoperability (PACIO) project can support nursing care.

Description: Nurses supporting patient care in acute and post-acute care (PAC) settings rely on EHR data to support patient care. However, there is currently an imbalance in what data are available – while interoperability is relatively common across acute care settings, a 2023 report from the assistant secretary for planning and evaluation found that interoperable systems are not often available or used across PAC settings. This means that those receiving PAC-based care have a hole in their record as they move from one facility to another or between acute care and PAC facilities. Lack of access to data can impact nurses’ ability to support patients’ care, leading to unnecessary burden of repeating assessments and tests that have already been completed elsewhere and medical errors, among other negative outcomes. The Centers for Medicare & Medicaid (CMS) has recognized this issue of interoperability and has supported policies and projects to improve interoperability, which in turn support clinicians and reduce burden.

Evaluation/outcome: CMS has sponsored the post-acute care interoperability project (PACIO), which is establishing a framework for the development of health level-seven (HL7®) fast healthcare interoperability resources (FHIR®)* implementation guides (IGs) to facilitate health information exchange between PAC and other entities. PACIO has applied user-centered design and evidence-based approaches to develop a PFE-specific HL7® FHIR® implementation guide (IG). PACIO has solicited perspectives from PAC practitioners, including nurses, and EHR implementers; integrated existing HL7 FHIR IGs; identified health data terminologies and standards; and mapped concepts to the World Health Organization (WHO) international classification of functioning, disability, and health (ICF) to address PAC data quality issues. In partnership with EHR and health information exchange (HIE) vendors and using synthetic patient data generated based on a scenario with an exemplar patient, PACIO has tested the PFE IG in multiple connectathons hosted by CMS and HL7. The connectathon results have demonstrated the technical capabilities of the IGs, provided opportunities to identify potential issues that implementers may face, and built a community among stakeholders who support PAC data quality. Next steps for PACIO include efforts to develop new use cases and improve the existing PFE IG through continued connectathon participation. PACIO welcomes ANIA members to participate in any PACIO work and events, as well as host a pilot at their institution.

The deployment of new technology is challenging in any setting. Whether it is a new surgical tool or new electronic health record, an appropriate level of operational readiness should be reached when introducing new technology in healthcare systems. Mobile health (mHealth) is one area of technological innovation in health care that can promote cost reductions, enhance access to health care, and improve the overall quality of patient care. As with any new technology implementation, there will also be a level of resistance to its adoption. Effective training is one key area that could increase clinicians’ intention to use mHealth tools, and it plays a central role in its success. Through the implementation of a new mHealth solution at an acute pediatric institution, training was a key feature of its operational readiness strategies.

The goal of operational readiness is to prepare the institution to adopt a newly introduced technology or device. Initially, a start-stop-continue template was developed to compare the legacy mobile application to the new mobile application and analyze what workflows would need to be created (start), modified (stop), or remain unchanged (continue). Next, solution validation sessions were held with subject matter experts (SME) and super users (SU) to ensure they were able to test and verify the appropriateness of the application features with their respective area's workflows in mind. This also allowed us to evaluate the end users’ level of expectations of the new implementation. According to Zadvinskis et al (2018), nurses’ expectations of health information that can influence adoption can be divided into five categories: ease of use, workflow and task performance, collaboration within the unit, communication across disciplines and departments, and effects on quality of care, which includes patient safety and satisfaction.

Training started with computer-based learning modules that were provided by the vendor. PowerPoint presentations and handouts were then developed by the project management team and the clinical informatics team, and they also conducted SU training. The team then brought training to the end users by holding roadshows and cafes. The benefit of roadshows was they could reach more end users at their own units at a time of their choosing, and sessions were geared towards their respective areas of expertise. The cafes enabled end users to come at their own time to a convenient central location, and they were strategically scheduled around times of shift change.

The success of the hands-on training was evident from the attendance numbers to the analytics of alerts received by roles claimed in the mobile communication application. Pre- and post-surveys also show a positive response to the new application vs. the legacy application. Feedback from end users for desired functionality and features was submitted for enhancements to the vendor. The operational readiness strategies helped to ensure the mHealth application aligned with the institutional goals of refined workflows, enhanced communication, and improved patient safety.

Purpose: Informatics educators and instructional designers at Stanford Health Care optimized our electronic health record (EHR) onboarding education of new providers and nurses by adopting cognitive, adaptive technology to increase learning efficiency and efficacy.

Background/significance: Most providers and staff enter our organization with prior EHR experience. Our goal was to optimize the onboarding program to include adaptability based on expertise and get the clinician to the bedside faster. We needed our learning methodology and technology to measure competency and capture analytic reporting for post-class personalized coaching.

Method: Six onboarding courses were chosen for a pilot, including five provider courses and one nursing course. We used a blended learning approach (synchronous and asynchronous learning) and the cognitive adaptive technology (CAT) (Amplifire authoring software) to create curriculum capable of adapting to the learner’s prior knowledge of the EHR. The CAT tests the learner’s comprehension, and the learner cannot complete the eLearning without demonstrating complete mastery. Post-eLearning completion analytics captures topic areas of struggle, which allows educators to provide personalized follow-up education.

Results: eLearning training time for providers was reduced by approximately one hour (2.5 hours reduced to 1.5 hours). Classroom time was reduced from 4 -16 hours (based on specialty) to 2 hours across specialties. Our inpatient RN course (nurses with experience in the EHR) was reduced from 4 hours of classroom time to 2 hours of self-paced learning. In our post-class surveys, learners report a positive experience

Conclusion/implications: Our optimization of EHR onboarding reduced training time.