THE SITUATION
The University of South Alabama Medical Center (USA) engaged Hit That Noggin to optimize the inpatient provider experience for the Children’s and Women’s Hospital General Pediatrics group.
USA’s General Pediatrics content was outdated and had been inadequately designed when initially implemented. Their workflow mPages weren’t functional due to poor integration with corresponding Dynamic Documentation templates, among other issues. A provider could not have feasibly started and finished an admission, progress, or discharge note without navigating multiple times outside the workflow mPage to other portions of the chart. Their group had largely stopped using the workflow mPages and instead were directly opening their note template to complete documentation.
"Before our optimization project we didn’t have any standardization within our documentation process. Everyone was using the system however they could make it work for them. Most of our team were opening note templates directly and totally skipping the workflow. In hindsight having everyone using PowerChart differently probably made documentation more difficult for both our residents and attending physicians.”
“I think there was very little use of the workflow mPage and if there was use of it, it was very inconsistent. All of the documentation was sort of haphazard, and people were doing what they were trained to do, not using a workflow… There was very little utilization of tools that were available. Some of our group were frustrated and in some cases not aware of things like autotext phrases. There was very little consistency.”
the solution
project timeline: 6 months
our approach
We began the project by analyzing the gaps between USA’s current configuration and Cerner’s standard content. This gap analysis was paired with initial planning meetings where we gathered specific pain points and needs from providers within the General Pediatrics group. We adopted an approach where we incorporated Cerner Model where it made sense to do so and supplemented it in places where the client’s needs superseded standard configuration.
We continued to hone and refine the General Pediatrics workflow through weekly meetings with the HTN project team and subject matter experts. This included nine different residents, mid-levels, and attending physicians from their group; engaging with a diverse group allowed us to gather a broad spectrum of ideas and opinions as well as spread the providers’ project time commitment more evenly to avoid creating a burdensome time commitment for any individual provider.
Throughout the course of the project we also collaborated with numerous ancillary groups that are key to the General Pediatrics group’s patient care. It was integral to our success that we didn’t silo our project team and instead approached the optimization with a broader focus to ensure cohesion with all the care providers that the General Pediatrics group works in coordination with.
“I think the team did a great job of managing our time commitments and giving us the things we needed in PowerChart. I liked that the HTN team started each phase of our project with a general plan and then adjusted based on our feedback. We always had a brainstorming session at the beginning of each project phase where we could call out specific problems and then have the team incorporate that into our broader plan. We felt heard throughout the process.”
“We appreciate everybody from the team working to make meetings as effective and helpful as possible… I felt like our time was respected even though it was a weekly commitment to be involved. I appreciated everyone from the team troubleshooting things and coming back to us to keep us updated. Even if it wasn't at a specific meeting time we could kind of run ideas by each other or clarify things offline.”
OUTCOMES
During three different go-lives we iteratively deployed our new content. This allowed us to introduce new functionality and meet education needs at a pace that was manageable for our providers. Each go-live was followed by a period of go-live support where we documented, troubleshot, and resolved issues in real time. After updates were deemed stable we conducted extensive handoff meetings with USA’s IT department to ensure they understood the changes made in the domain and how to maintain the new configuration.
Hit That Noggin:
- Implemented three optimized General Pediatrics workflow mPages for admission, progress, and discharge documentation. Included new Shared Content components allowing providers share their ROS, Hospital Course, Plan, PE, and Patient Instructions across users.
- Created new structured documentation for specialized intake assessments.
- Implemented a new Nursing Discharge Workflow for nursing users to create an integrated Patient Instructions document.
- Created English and Spanish versions of the Patient Instructions Dynamic Documentation template.
- Updated Quick Orders mPage contents based off of provider ordering behavior audits.
“It was really awesome working with the consulting team. We introduced a ton of positive change in a pretty short amount of time. It always felt like they were invested in what was best for our Pediatric group. Our documentation is much more thorough and efficient now. Our residents love the time that the shared components save them.”
“I was very impressed with the team. I was involved with past implementations where things were not cohesive, so I was a bit cautious going into this optimization project. The team worked hard to make sure everyone was in sync and then doing the work on the ground to get people on board as quickly as possible and keeping them updated as we progressed through our project.”
