One-click Ordering Promotes Preventive Care, Eases Provider Workflow

Six in 10 Americans have a chronic illness, reports the Centers for Disease Control and Prevention.

“Chronic illnesses are often preventable when detected early,” says Eric Boose, MD, a Cleveland Clinic family medicine physician and Associate Chief Medical Information Officer. “With routine preventive care, such as screenings, immunizations and procedures, patients can improve their overall wellbeing.”

Healthcare best practices and national clinical guidelines drive preventive care recommendations. A “gap in care” exists when those recommendations don’t align with the care provided to patients, so closing care gaps is essential to prevent missed or delayed diagnoses.

Dr. Boose adds, “Patients delay care for various reasons. Oftentimes, we’re seeing patients when they’re experiencing acute symptoms. Regardless of the reason, this is an ideal time to address any care gaps. But we needed a frictionless workflow for providers to place the necessary orders while giving our patients easy scheduling options.”

Initially a manual process within the electronic health record (EHR), providers relied on a checklist to place the appropriate orders.

“Given our heavy patient volume, it was cumbersome keeping track of the available wellness screenings and determining which ones were appropriate for each patient,” Dr. Boose explains.

Turning to one-click ordering created a seamless workflow to easily access and order the applicable screenings.

Segue to one-click ordering

In late 2019, upgrades to Cleveland Clinic’s EHR portal included an improved view of patient details on the Storyboard, a patient-specific navigational tool. With this new functionality, providers could easily view, address and close individual care gaps with one-click ordering.

“One-click ordering eliminates extra work for providers,” says Annie Foliano, a Cleveland Clinic systems analyst. “The improved workflow involved applying rules and building algorithms to automate and align the patient-specific diagnosis to the appropriate order.”

Cleveland Clinic Information Technology Manager Jennifer Zarzecny points to standardization as a benefit.

“Pushing toward standardization simplifies the technical build and improves care consistency.” Zarzecny continues, “Having clinical input and decision support maintains the tool’s accuracy and expedites any necessary adjustments.”

One example is the influenza vaccine.

Foliano describes, “In working with Dr. Boose, we created a standardized algorithm that looks at the patient’s age when the order was placed. Using age-specific groups, the order automatically links to the appropriate influenza vaccine.”

“Providers appreciate the improved workflow’s efficiency.” Dr. Boose continues, “The faster process removes unnecessary steps — by clicking one button, the system knows the proper order. It’s an incredible timesaver.”

Zarzecny adds, “With optimized functionality and standardized build, daily usage of one-click ordering has grown by 800% since 2020. This sharp uptick in provider usage speaks to the tool’s efficiency and value.”

Simplicity, support and maintenance boost usage

There are over 50 one-click ordering options available from the Storyboard since its 2019 launch.

“Providers can personalize which topics to address with a patient during their visit,” says Foliano. “By defaulting to associated diagnoses, providers save time and clicks without having to make additional selections.”

The team applied custom sorting to prioritize visibility at the top of the Storyboard for each patient encounter. They also used immunization sequencing logic to automatically suggest the most accurate vaccine when ordering.

Dr. Boose explains, “The Storyboard provides a concise visual of each patient’s needed preventive care actions. It simplifies the talking points to what’s important during the visit and the next steps for the patient, which may include self-scheduling through MyChart.”

Over the last year, patients with MyChart accounts have self-scheduled 82,000 mammograms and 25,000 colonoscopies.

Governance and maintenance also contribute to the tool’s ongoing success and usage.

Decision-making and updates stem from the Disease Management Prevention Task Force, a multidisciplinary team that meets monthly.

“With the Task Force’s guidance and clinical input, we can quickly update the tool.” Zarzecny continues, “This immediate response ensures providers have accurate, current information when suggesting preventive care measures to their patients.”

The team maintains an inclusive spreadsheet to track order changes, troubleshoot and facilitate onboarding at new locations.

Dr. Boose summarizes, “We’re still catching up on patient visits from the onset of COVID-19 in March 2020. Shifting to one-click ordering quickens the process by narrowing the focus to what’s imperative for each patient. In healthcare, our goal is to keep patients healthy. This means supporting our patients by preventing healthcare issues, and equally important, to improve their quality of life.”