Ori Lotan, MD, and Marreddy Yeruva, MD, CMIOs at Universal Health Services, Inc. (UHS), were honored at the Spring Cerner Physician Community Meeting with the Documentation All-Star Award. Dr. Lotan shared with us how the organization is implementing dynamic documentation across 25 acute care facilities and the solution’s impact on clinicians and patients.

1. Why did you decide to do a complete wraparound of the dynamic documentation solution with custom components?

At UHS, inpatient physician documentation is the third phase of our Cerner implementation across 25 acute care hospitals. When we looked at the dynamic documentation solution in 2014, we found opportunities to innovate in order to provide a complete documentation solution with embedded advanced clinical decision support. Our team ultimately designed and integrated roughly 10 custom components into dynamic documentation using Cerner tools such as the mPage developer’s toolkit and smart templates. UHS’s goal was to provide busy physicians with a one-stop shop for reviewing the electronic chart and providing and documenting patient care, with the most automation and the minimal amount of effort.

2. UHS has seen 50- to 90-percent reductions in transcriptions using dynamic documentation. What does this mean for clinicians? How does dynamic documentation benefit them?

So far, we’ve implemented the enhanced dynamic documentation solution across seven facilities since December and will complete almost all of the remaining hospitals in 2015. We’ve seen good voluntary adoption by independent community doctors who practice at our hospitals and are pleased to report transcription reductions in the 50 to 90 percent range (which exceeded our goal of 30 percent reduction). Hundreds of dynamic documentation notes are being generated daily at each of the hospitals, and the feedback from physicians has been very positive, including surgeons and sub-specialists.
We do see benefits to physicians from using dynamic documentation. Completing required documentation efficiently and in real time reduces the need for physicians to remember to review, correct and sign dictated documents. It also eliminates penalties, such as suspension of hospital privileges for medical record deficiencies, if you fall behind on your dictations. Our configuration of dynamic documentation can pull in 70 to 80 percent of the discharge summary, which is a big time saver for clinicians.

3. How does Dynamic Documentation improve the patient experience?

We believe that having physician notes available in real time (as opposed to waiting to be transcribed and reviewed) enhances patient care and safety by improving communication and dissemination of information among all the clinicians. Since we built a lot of clinical decision support into the solution, we have an opportunity to improve many quality and patient safety measures by presenting them at the right time in the physician’s workflow.
For example, when a physician adds a diagnosis that has associated core measures such as myocardial infarction, we will immediately pop up an advisor that will show whether the specific core measures have been met (check mark and green indicator) or not (alert icon and red indicator). All deficiencies can immediately be addressed from this advisor by placing an order or documenting a contra-indication.
We have several of these smart advisors and MPage components built to naturally occur in the workflow to improve patient care, which is what a robust tool like an integrated EMR should be helping us do. Receiving excellent, evidence-based care, improved communication among members of the care team and more satisfied physicians all positively impact the patient experience.