Background: Despite the widespread use of technology across our daily lives, many processes in the hospital remain manual and labor-intensive. As hospital medicine divisions grow, there is an increasing need for automated and scalable solutions. While many hospitals look to external vendors to provide automated solutions, these often lack customizability and gaps remain.

Purpose: To build a core facility that develops automated and scalable solutions to manual, time intensive processes in the hospital.

Description: Concept and Needs AssessmentAt our 700-bed adult hospital, the hospitalists manage 150 – 200 patients on teaching and non-teaching services. The division includes 90 hospitalists and 15 staff. We identified several complex workflow issues amenable to automation, including (1) distribution of patients admitted overnight to the hospital to teaching and non teaching teams; (2) effective ways of distributing a sizable body of inbound faxes to the correct attending provider for notification and signature; and (3) timely and accurate delivery of bi-directional resident evaluations.Program and BuildWe developed the “Applet Core” to build apps that connect tools and data sources with the goal of automating and streamlining processes. The group consisted of a single developer with excellent cross-platform skills, two physician informaticists and one quality and safety leader. The total annual cost of the program was $200K per year. Case 1: CyberRaptor – Approximately 60% of hospital medicine patients are admitted overnight and need to be “distributed” to a daytime primary team. CyberRaptor combines Electronic Health Record (EHR) data regarding team census and patient details with information from the scheduling software regarding team members and position in the call cycle to automate distribution communication. It allows an overnight hospitalist to quickly generate a distribution email and has saved approximately 7 hrs/week for night hospitalists.Case 2: CyberFax – Over 60 clinical faxes are received by the division weekly. Prior to the implementation of CyberFax, these were sorted manually by staff and emailed to the appropriate clinician. CyberFax utilizes optical character recognition to sort the faxes digitally and deliver them to the appropriate clinician in docusign form, saving staff approximately 2 hrs/week.Case 3: CyberEval – Delivery of evaluations were previously a manual process; an administrator looked at scheduling data to determine when and for how long trainees worked with attendings or senior residents, necessitating approximately 10 hrs/week of an administrator’s time. CyberEval consists of a set of heuristics that leverages Amion™ scheduling data to automate this allocation process, saving 5 hours per week of manual work.Future DirectionsAdditional tools in development and pilot including CyberLog, an app that enables review and submission of EHR-derived work hours to Medhub™, CyberStream, an app that displays a constant feed of clinical updates for patients on one’s team list, and CyberPage, a tool that automates routine pages which are currently manual.

Conclusions: We created the Applet Core to automate highly manual workflows. We significantly improved clinical and staff efficiency in multiple domains, and expect the cost of the Applet Core to offset by these improvements over time.