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Integrating Clinical Input Into Digital Tools Tightens Workflow

A centralized electronic tool improved clinical oversight and operational efficiency

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Digital tools are increasingly augmenting clinical processes and workflows to streamline care.


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At Cleveland Clinic, leveraging this potential brings together clinical and Information Technology Division (ITD) experts to develop digital solutions that optimize workflows. This often starts with ITD teams evaluating existing tools within their electronic health record (EHR) system.

“Developing solutions with our current EHR applications leads to a quicker project turnaround, minimal training and financial savings,” says Debra Narayan, ITD specialty procedural applications director at Cleveland Clinic. “Plus, accessing data directly from the EHR improves the integrity and continuity of the patient’s health record.”

An example of this collaborative approach paired Narayan’s team with clinicians from Cleveland Clinic’s Bariatric and Metabolic Institute (BMI) to develop an automated solution to their manual workflow.

Manual review duplicates care team’s efforts

Ten thousand active patients and 4,000 new patients enroll in the BMI program each year.

“Our patients undergo a comprehensive evaluation process to determine surgical eligibility. This entails several visits with our multidisciplinary team to meet clinical and insurance requirements,” says Xiaoxi Feng, MD, a Cleveland Clinic bariatric surgeon.

While certain clinical milestones are mandatory, a patient’s insurance may require additional visits.

Dr. Feng explains, “Appointments are self-paced and nonsequential, which complicates oversight of a patient’s progress. Without a centralized view, our team was individually reviewing each patient chart to determine their status. Gathering these details was a time-consuming scavenger hunt.”

Automation reduces inefficiencies

During the project intake phase, the clinical team detailed a cumbersome workflow to monitor their patient’s progress throughout the evaluation process.

Dr. Feng explains, “Our priority was to tighten our workflow with digital functionality that would seamlessly display our patients’ progress.”

Team discussions landed on a centralized patient tracking tool within the EHR system that would reduce duplicative work while assisting patients through their evaluation.

“The BMI process map showed various appointment scenarios and patient milestones, that if missed, would delay their surgery,” says Narayan.

The teams met weekly to discuss the process map and identify the existing EHR applications and the needed functionality to automate the manual process.

“These meetings allowed for frequent problem-solving sessions to integrate clinical input into our configuration builds.” Narayan adds, “When the initial solution wasn’t the right fit, the analysts worked together to develop a better approach before moving on to the next step.”

Dissecting the process map into individual steps allowed the team to creatively adapt the manual workflow into EHR functionality by using smart data elements to capture discrete data that accurately identified the BMI program patients.


“Once the patients were identified, the analysts added reporting functionality to gather the discrete data points into a registry. This allows for the EHR system to data mine all the patients from the BMI program into a comprehensive list,” says Narayan.

Dr. Feng and Narayan credit Cheri Pfeiffer, a lead clinical analyst from Narayan’s team, with designing the final tool.

Praising Pfieffer, they say, “Making this tool a reality stems from her extensive knowledge and background with our existing applications coupled with her ability to reconfigure these into an operational solution.”

“This intuitive, customizable reporting tool filters patient data into an easy-to-use, color-coded format that expedites our access and workflow.” Dr. Feng continues, “There’s a noticeable improvement now that these EHR capabilities are connected into one tool.”

Dr. Feng reports that surgical volume has increased over the last few months despite a nationwide decline in bariatric surgery.

“The only adjustment we made during this timeframe was transitioning to our automated process, which tells me our new monitoring capabilities are working,” says Dr. Feng.

Extending blended approach

Given the tool’s success, Dr. Feng sees potential for more digital optimization.

“Our comprehensive BMI program is an ongoing partnership with our patients to prepare them for surgery and beyond,” says Dr. Feng. “Just as we have benefited from access to this information, the same is true for our patients.”

Looking ahead, the teams are exploring patient-facing tools that would encourage ongoing patient interactions.

On that note, Dr. Feng adds, “My patients’ motivation to achieve and sustain a healthier lifestyle doesn’t end after their surgery. Using technology to complement our clinical support would keep our patients engaged and informed throughout their healthcare journey. Expanding our digital toolbox is essential to broaden our reach and impact.”


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