Abstract
Background The Clinical Monitoring List (CML) is a real-time scoring system and intervention
tool used by Mayo Clinic pharmacists caring for hospitalized patients.
Objective The study aimed to describe the iterative development and implementation of pharmacist
clinical monitoring tools within the electronic health record at a multicampus health
system enterprise.
Methods Between October 2018 and January 2019, pharmacists across the enterprise were surveyed
to determine opportunities and gaps in CML functionality. Responses were received
from 39% (n = 162) of actively staffing inpatient pharmacists. Survey responses identified three
main gaps in CML functionality: (1) the desire for automated checklists of tasks,
(2) additional rule logic closely aligning with clinical practice guidelines, and
(3) the ability to dismiss and defer rules. The failure mode and effect analysis were
used to assess risk areas within the CML. To address identified gaps, two A/B testing
pilots were undertaken. The first pilot analyzed the effect of updated CML rule logic
on pharmacist satisfaction in the domains of automated checklists and guideline alignment.
The second pilot assessed the utility of a Clinical Monitoring Navigator (CMN) functioning
in conjunction with the CML to display rules with selections to dismiss or defer rules
until a user-specified date. The CMN is a workspace to guide clinical end user workflows;
permitting the review and actions to be completed within one screen using EHR functionality.
Results A total of 27 pharmacists across a broad range of practice specialties were selected
for two separate two-week pilot tests. Upon pilot completion, participants were surveyed
to assess the effect of updates on performance gaps.
Conclusion Findings from the enterprise-wide survey and A/B pilot tests were used to inform
final build decisions and planned enterprise-wide updated CML and CMN launch. This
project serves as an example of the utility of end-user feedback and pilot testing
to inform project decisions, optimize usability, and streamline build activities.
Keywords
clinical information systems - clinical decision support - monitoring and surveillance
- workflows and human interactions
