Background: While hospitalists pursue a primarily clinical role, we have carved a niche in clinical research, particularly Quality Improvement based research. However, clinical research often involves time intensive chart review, which can become a barrier to hospitalists with heavy clinical roles. A mechanism to mitigate this will be revolutionary.
Purpose: In this innovations abstract, we describe how we harnessed our electric medical record (EMR) to improve the efficiency of research, and hence make it more accessible to hospitalists with significant clinical responsibilities.
Description: We set out to identify factors contributing to patient upgrades within 24 hours of admission, a marker for quality improvement. In the summer of 2021, we recruited three first year medical students as part of a summer medical student research program. We identified 35 factors to review, and over 600 patients who met the criteria for inclusion. We initially planned to chart review all data, but it became apparent that each chart would require over 30 minutes. On reevaluating the factors to be studied, we determined that the majority could be obtained through running an automated report within our EMR. We worked closely with IT to identify data points and develop a customized automated report. This did involve building custom queries as some data could not be collected in a standard report. Ultimately, only five data points per chart, required manual chart review by a person. We reduced the time from 30 minutes to less than 10 minutes per chart, a reduction from 300 hours in total to under 100 hours.
Conclusions: With the advent of EMR, one promise was the potential to accelerate the pace of research. We were able to implement an automated report to accomplish just that. We reduced the data collection process from months to weeks, freeing time to engage in targeted chart review and data interpretationOften the questions related to organizing a research project revolve around how to recruit for, divide up, and allocate time for chart review. However, with the advancements in technology especially electronic medical records, we should ask, “Do we need to do manual chart reviews? What data can we gather through a software process?” Harnessing technology to assist with data collection frees our time to engage in the creative process of data interpretation, making better use of our clinical expertise. Data becomes more accurate as inter-operator variability is almost eliminated. Manual chart review becomes targeted to more complex data points. Additionally, advances in artificial intelligence (AI) can further accelerate the pace of research, as machine learning can be used to identify patterns and correlations as targets for further study.Barriers remain, though. Not all have access to the technology and support from IT required to carry out this type of work. Some degree of technology knowledge is required to develop and appropriately communicate realistic goals to our colleagues in IT.Ultimately, the advancements in information technology and AI with the adoption of EMR offer the potential to revolutionize the way we conduct research. Hospitalists can be very successful in research due to our clinical experience and broad knowledge base. Leveraging the EMR makes this possible for those with a large clinical role to participate in meaningful research to improve patient care.