Abstracts

Rationale: Clinical documentation of medical information within the electronic medical record (EMR) is not structured, consistent, or discreet thus placing significant limitations on its use for clinical and research purposes. We developed and implemented a system within our EMR for providers to consistently and accurately chart seizure types and frequencies so that the data can be directly extracted and analyzed. Methods: Epilepsy team members, Information Management, and IT staff met weekly over several months to develop the content, determine the workflow for different providers, and identify the best tool within EPIC for creating the instrument. During development, a subgroup of the team tested the system at different stages and revisions were made based on the preliminary experiences. A doc flowsheet was determined to be the most efficient means for tracking seizures. Results: Seizures are first identified based on the ILAE classification.  At each contact, the duration and frequency of each seizure type is updated in the flowsheet in addition to the date of most recent seizure. Clinicians given access were all attending physicians, APNs, and nurses. Initially using the flowsheet appeared cumbersome as this was a change in workflow that required an additional step; however, after entering the initial data in the flowsheet, updating information is very quick.  The information from the flowsheet can be pulled directly into a note, streamlining the documentation process. The data can also be pulled directly into a synopsis that allows frequency to be graphed over time to aid in assessing response to treatments. A three-question survey was sent to the 11 providers in the epilepsy center asking about their initial experience with using the seizure tracker. The response rate to the survey was 9/11 (82 %.) Of the nine providers that responded, 5/9 (56 %) used the seizure tracker with most or all patient encounters. Those same providers felt that it was somewhat easy or very easy to incorporate the seizure tracker into their workflow for documentation as well as noted that there was moderate to great improvement in their ability to find and understand the information from the seizure tracker in reviewing notes.  Conclusions: The seizure tracker is the first step of a larger project that will systematize our documentation of etiologies and specific epilepsy syndromes, medications, and other important features of children with epilepsy. This will make charting more efficient, more accessible for providers, and will create a valuable and efficient data resource of quality improvement and other research.  Funding: No funding