Abstracts

Rationale: Within the Epilepsy Learning Healthcare System (ELHS), Barrow Neurological Institute’s (BNI) Epilepsy clinic contributes to a central data registry used to improve patient outcomes. By collecting patient reported outcomes (PROs) prior to the visit, providers can address patient concerns promptly during the visit and track critical metrics over time. Digitizing data collection engages providers and patients in the process, as both find meaning in instantly displayed summarized presentations of this data. Using quality improvement (QI) methodology, BNI established a process to collect data digitally and is continuously improving it with a goal to integrate data collection and processing into the clinic workflow and provide meaningful data analytics to patients and providers at the time of the visit.

Methods: The QI team initially designed a process map to collect data in parallel to clinical workflows (Figure 1). Key stakeholders in this process were interviewed to provide input into the steps needed to collect data. There is no automated data exchange from the electronic health record (EHR) at BNI to the data registry and data is recorded in the clinic note as free text. Thus, the QI team created a local database and performed manual chart reviews prior to the clinic visit to collect historical data, a clinician verified the chart review for clinical accuracy, patients filled out PRO questionnaires prior to their clinic visit, and the provider collected provider-facing data concurrently with the clinic visit or shortly after when entering the clinic note into the EHR. Time spent at each step is shown to highlight waste and act as a baseline for improvement.

Results: The initial process had many manual steps for the QI team, minimal PROs, and minimal provider-reported data. Providers were unable to review PROs at the time of the clinic visit and entering the same data in a clinic note and a database was inefficient and added wait time. In all, the maximum time to collect and process data was 351.25 hours and the minimum was 15.25 hours. PDSAs were conducted to improve data collection rates (PROs, provider data, QI team data) by expanding the patient pool, increasing patient communications to raise awareness of PROs, creating a summary report with PROs to share with providers at the time of visit, and by minimizing manual steps in the process. The current process highlights these changes to support QI (Figure 2).

Conclusions: Despite adding to the overall data collection time (Max: 1035.75 hrs; Min: 15.75 hrs), more patients respond to PROs, providers do not waste time on double data entry, and the QI team is creating new solutions to maximize automated steps and reduce wait times. The next step is a standardized template to structure data within the clinic note, to be used while the QI team works to integrate data collection into the EHR and potentially support further automation to the data registry. Based on the current process, BNI is actively integrating QI data into the clinic, and succeeding at engaging patients, providers, QI staff and healthcare leaders in improving health outcomes for epilepsy patients.

Funding: Please list any funding that was received in support of this abstract.: N/A.