Pouya Ameli, MD, MS 
Naveen Baskaran, MD 
Brian Lobo, MD Leveraging the EHR for Quality Improvement
The Electronic Health Record is far more than a digital chart; it is a dynamic environment for driving meaningful quality improvement. Leveraging it effectively involves two key activities: exploring data to identify opportunities and implementing tools to create solutions. Both of these activities must be guided by a strong ethical framework that protects patient privacy and ensures data is used responsibly.
Powerful self-service analytics tools, such as SlicerDicer, empower clinicians to ask direct questions of their own clinical data. This allows teams to identify trends and uncover patient safety issues or workflow inefficiencies that may not be obvious on the surface. This data exploration is often the critical first step that informs a focused and impactful QI project.
Once an opportunity is identified, the EHR offers a platform for clinician-led innovation. As demonstrated in the case study on improving neurology transfers, a motivated physician can work with frontline users to build and implement highly effective tools—like a “smart phrase” for handoffs—without needing a formal IT project. This approach, grounded in the principles of clinical informatics, ensures that solutions are practical, efficient and seamlessly integrated into the daily workflow, leading to safer and more reliable patient care.
Resources
The resources below provide a practical look at these concepts in the real world. From a clinician-led case study to foundational guidance on informatics, ethics and data exploration, these materials will equip you to leverage the EHR responsibly and effectively in your own quality improvement work.
Clinical Informatics: The EHR
Learn the fundamentals of clinical informatics and how it serves as a bridge between medicine and technology. This video explains the “three pillars”—people, process and technology—and the “five rights” of clinical decision support, providing a framework for optimizing the EHR to improve workflows and patient outcomes.
Standardize Processes with EHR Templates and Smart Tools
One of the most effective QI strategies is reducing unwanted variation in care. The EHR can be a powerful ally in this effort through the use of templates, smart phrases, and standardized notes that ensure critical information is captured consistently.
Case Study: Enhancing Patient Safety in Neurology Transfers through a Collaborative, Standardized Handoff Tool
This case study details how a clinician-led team addressed a high-risk communication gap during patient transfers between the Neuro ICU and the general neurology service. To ensure safer handoffs, the team developed a standardized transfer note directly within the EHR by building a “smart phrase” and “smart list.” This approach allowed for rapid development and deployment without relying on formal IT project cycles. By involving residents and APPs in the design process, the team created a practical tool that improved communication for over 40 clinicians and led to a marked decrease in preventable adverse events and ICU “bounce-backs.” The project highlights how motivated clinicians can leverage existing EHR functionality to quickly and effectively improve patient safety.
Explore the Neurology Transfer Patient Safety Case Study
Key takeaways of the case study:
- Motivated clinicians can lead powerful innovation by leveraging existing EHR tools to create and implement effective solutions rapidly, without relying on formal IT development cycles.
- Collaboration is essential for adoption; involving frontline end-users like residents and APPs in the design process ensures the resulting tool is practical and gains widespread buy-in.
- Designing a tool to be efficient and integrate easily into the existing clinical workflow is crucial for its adoption and sustained use.
- Standardizing handoffs with a permanent, written record in the EHR enhances patient safety by ensuring critical information is reliably accessible to the entire care team.
Case Study Video: Enhancing Patient Safety in Neurology Transfers through a Collaborative, Standardized Handoff Tool
Watch a narrative overview of how a neurology team addressed a critical patient safety risk by creating a standardized transfer note in the EHR. In this video, Pouya Ameli, M.D., M.S., assistant professor of neurology and neurosurgery, highlights the importance of capturing nuanced clinical decision-making and using anticipatory guidance to prevent adverse events, showcasing a model for rapid, clinician-led innovation.
Data Considerations when Using EHR/CDS Tools for QI
Brian Lobo, M.D., rhinology, sinus and skull base surgeon, helps you to understand the roles of EHR and CDS in standardizing healthcare processes. Learn the difference between a QI initiative and a research project, and articulate the importance of this distinction. Finally, Dr. Lobo explains why knowing the source, collection method, and context of data is critical for its effective use in a QI project.