February 24, 2021

Creation and Implementation of an Electronic Health Record Note for Quality Improvement in Pediatric Epilepsy: Practical Considerations and Lessons Learned

Summary, originally published in Epilepsia Open

Objective: To describe the development of the Pediatric Epilepsy Outcome-Informatics Project (PEOIP) at Alberta Children’s Hospital (ACH), which was created to provide standardized, point of care data entry; near-time data analysis and availability of outcomes dashboards as a baseline on which to pursue Quality Improvement.

Methods: Stakeholders involved in the PEOIP met weekly to determine the most important outcomes for patients diagnosed with epilepsy, create a standardized electronic note with defined fields (patient demographics, seizure and syndrome type and frequency and specific outcomes (seizure type and frequency, adverse effects, emergency department visits, hospitalization) and care pathways for clinical decision support. These were embedded in the electronic health record from which the fields were extracted into a data display platform that provided patient and population level dashboards updated every 36 hours. Provider satisfaction and family experience surveys were performed to assess the impact of the standardized electronic note.

Results: In the last 5 years, 3,245 unique patients involving 13, 831 encounters had prospective, longitudinal, standardized epilepsy data accrued via point of care data entry into an electronic note as part of routine clinical care. A provider satisfaction survey of the small number of users involved indicated that the vast majority believed that the note makes documentation more efficient. A family experience survey indicated that being provided with the note was considered ‘valuable’ or ‘really valuable’ by 86% of respondents and facilitated communication with family members, school and advocacy organizations.

Significance: The Pediatric Epilepsy Outcomes-Informatics Project serves as a proof of principle that information obtained as part of routine clinical care can be collected in a prospective, standardized, efficient manner and be used to construct filterable, process/outcomes dashboards, updated in near time (36 hours). This information will provide the necessary baseline data on which a multiple of QI projects to improve meaningful outcomes for children with epilepsy will be based.

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