Abstract NS10: Development of a Comprehensive Stroke Center Electronic Medical Records Navigator: Experience in one Academic Stroke Center

Abstract

Electronic medical records (EMR) have become the standard of care for documentation in today’s health care settings. The EMR system allows for standardization of care and widespread access to information with ability to subsequently evaluate that care. Additionally, trends are more easily documented and monitored. Development of a stroke specific EMR system for a comprehensive stroke center (CSC) was the goal from the initiation of our multidisciplinary steering committee. Our center enlisted the stroke nursing and physician teams, administration, health services researcher, quality and clinical informatics teams to develop an EMR navigator tool based on guidelines from the American Heart/Stroke Association (AHA/ASA) in anticipation of being an early CSC. It was designed to be used for all patients with a diagnosis of stroke during hospitalization. The informatics team developed a method to capture proposed CSC metrics and quality indicators. Progress notes were developed to auto populate necessary data using a specific template. Order sets were standardized according to AHA/ASA guidelines. Discrete fields were built into the EMR to ensure data could be automatically aggregated to evaluate quality-of-care for all stroke patients without requiring chart review. Efforts were made to ensure ease of use and efficiency while preventing errors. The navigators were designed to allow for reports required by Joint Commission to be more readily run on a regular and ongoing basis. Clinical informatics worked with representatives from EPIC to develop custom code for unique situations such as “door to needle time,” as required by Joint Commission. Smart phrases were identified when able, but minimized to prevent duplicity and erroneous assessment and documentation. Stroke patients often require complex interdisciplinary team care. Having a stroke navigator EMR in place enables all health care providers to have consistent access to information at hand to improve our ability to provide comprehensive care. Cues for care can be provided, improving safety and preventing errors. It also enables standardization of data extraction with ability to track progress between notes and trend data in spread sheet format.