Electronic medical record redesign to improve patient safety and use of non-medication orders by clinicians

Background: Electronic medical records (EMRs) have become highly customizable. Although customization allows changes for workflow optimization, such changes can result in a less standardized system and create barriers due to individual preferences. Aim: This was a documentation of the efforts of a greenfield academic medical centre in Qatar to improve patient safety, physician operational efficiency and revenue capture by standardizing the design of the non-medication orders and associated revenue of the EMR. Methods: A multi-disciplinary group reviewed and revamped the design and workflow for non-medication orders, including redistributing orders into order catalogues, standardizing their naming, assigning them billing codes, and reviewing other order details. Measurement of project performance followed cross-sectional and prospective cohort designs. Results: The redesign improved clinicians' satisfaction with the EMR and reduced patient safety incidents and other technical issues. Improvements in the organization's operations and staff performance were noticeable across multiple areas. The proportion of clinicians finding it difficult to navigate and select orders reduced from 31% to 21%. The proportion of clinicians who believed the orders to be clear and accurate increased from about 16% to 31%. The estimated percentage of clinicians reporting a technical issue with an order during the last month reduced from 52% to 41.94%, and physicians' dissatisfaction with the overall organization of non-medication orders in the EMR reduced from about 32% to 23%. The average number of technical issues and change requests sent monthly to the technology team for non-medication orders reduced from 30 to 1.4 technical issues and 3.2 change requests. Conclusion: EMR performance improvement projects that consider and address staff input, patient safety and performance metrics can uplift an organization's clinical and financial performance. Keywords: medical informatics, clinical decision-making, electronic health records, health information systems, medical order entry system, Qatar