Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center

Kensaku Kawamoto; Polina V Kukhareva; Charlene Weir; Michael C Flynn; Claude J Nanjo; Douglas K Martin; Phillip B Warner; David E Shields; Salvador Rodriguez-Loya; Richard L Bradshaw; Ryan C Cornia; Thomas J Reese; Heidi S Kramer; Teresa Taft; Rebecca L Curran; Keaton L Morgan; Damian Borbolla; Maia Hightower; William J Turnbull; Michael B Strong; Wendy W Chapman; Travis Gregory; Carole H Stipelman; Julie H Shakib; Rachel Hess; Jonathan P Boltax; Joseph P Habboushe; Farrant Sakaguchi; Kyle M Turner; Scott P Narus; Shinji Tarumi; Wataru Takeuchi; Hideyuki Ban; David W Wetter; Cho Lam; Tanner J Caverly; Angela Fagerlin; Chuck Norlin; Daniel C Malone; Kimberly A Kaphingst; Wendy K Kohlmann; Benjamin S Brooke; Guilherme Del Fiol

doi:10.1093/jamiaopen/ooab041

Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center

JAMIA Open. 2021 Jul 31;4(3):ooab041. doi: 10.1093/jamiaopen/ooab041. eCollection 2021 Jul.

Authors

Kensaku Kawamoto^{1

2}, Polina V Kukhareva^{1

2}, Charlene Weir¹, Michael C Flynn^{2

3

4}, Claude J Nanjo^{1

2}, Douglas K Martin^{1

2}, Phillip B Warner^{1

2}, David E Shields^{1

2}, Salvador Rodriguez-Loya^{1

2}, Richard L Bradshaw^{1

2}, Ryan C Cornia^{1

2}, Thomas J Reese¹, Heidi S Kramer¹, Teresa Taft¹, Rebecca L Curran^{1

5}, Keaton L Morgan^{1

2

6}, Damian Borbolla¹, Maia Hightower^{2

4}, William J Turnbull², Michael B Strong^{2

4}, Wendy W Chapman¹, Travis Gregory², Carole H Stipelman^{2

7}, Julie H Shakib^{2

7}, Rachel Hess^{2

4

8}, Jonathan P Boltax⁹, Joseph P Habboushe^{10

11}, Farrant Sakaguchi^{2

3

5}, Kyle M Turner^{2

3

12}, Scott P Narus^{1

13}, Shinji Tarumi¹⁴, Wataru Takeuchi¹⁴, Hideyuki Ban¹⁴, David W Wetter^{8

15}, Cho Lam^{8

15}, Tanner J Caverly^{16

17}, Angela Fagerlin^{8

18}, Chuck Norlin^{2

7}, Daniel C Malone¹², Kimberly A Kaphingst^{15

19}, Wendy K Kohlmann^{2

15}, Benjamin S Brooke^{1

6}, Guilherme Del Fiol¹

Affiliations

¹ Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
² University of Utah Health, Salt Lake City, Utah, USA.
³ Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.
⁴ Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
⁵ Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA.
⁶ Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
⁷ Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
⁸ Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.
⁹ Division of Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
¹⁰ MD Aware, LLC, New York, New York, USA.
¹¹ Department of Emergency Medicine, New York University, New York, New York, USA.
¹² Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
¹³ Intermountain Healthcare, Murray, Utah, USA.
¹⁴ Research & Development Group, Hitachi, Ltd, Tokyo, Japan.
¹⁵ Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
¹⁶ VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.
¹⁷ Departments of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA.
¹⁹ Department of Communication, University of Utah, Salt Lake City, Utah, USA.

Abstract

Objective: To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations.

Materials and methods: We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations.

Results: University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape.

Discussion: Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation.

Conclusion: EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.

Keywords: CDS Hooks; FHIR; SMART on FHIR; clinical decision support; electronic health record; interoperability standards.

Abstract

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