Coupled Effect of Electronic Medical Record Modifications and Lean Six Sigma Methodology on Rheumatoid Arthritis Disease Activity Measurement and Treat‐to‐Target Outcomes

Abstract

Objective Rheumatoid arthritis (RA) disease activity assessment is critical for treatment decisions and treat to target (T2T) outcomes. Utilization of the electronic medical record (EMR) and techniques to improve the routine capture of disease activity measures in clinical practice are not well described. We leveraged a Lean Six Sigma (LSS) approach, a data‐driven five‐step process improvement and problem‐solving methodology, coupled with EMR modifications to evaluate improvement in disease activity documentation and patient outcomes. Methods A RA registry was established, and structured fields for Routine Assessment of Patient Index Data (RAPID3) and Clinical Disease Activity Index (CDAI) were built in the EMR, along with a dashboard to display provider performance rates. An initial rapid‐cycle improvement intervention was launched, and subsequent LSS improvement cycles helped in standardization of clinic workflow, modifying provider behaviors, and motivating better documentation practices. Trends related to CDAI score categories were compared over time using run charts. Results Our project included 1322 patients with RA and 10 241 encounters between April 2016 and December 2019. Initially, RAPID3 completion rates increased from 16% to 50%, and CDAI from 15% to 44% from the RCI intervention. Post LSS intervention, the RAPID3 rate increased to more than 90% (sustained at 85%), and CDAI rate increased to more than 80% (sustained at 72%). The patients in the low disease/remission category increased from 54% to 66% (p < 0.001), and those in the high disease category decreased from 15% to 7% (p < 0.001), demonstrating improved T2T outcomes. Conclusion Combining EMR modifications with systems redesign utilizing LSS approach led to impressive and sustained improvement in disease activity documentation and T2T outcomes.

Improving Delirium Assessments in Vanderbilt Pediatric and Pediatric Cardiovascular Intensive Care Units

“…19 Our study thus extends the previous literature demonstrating the efficacy of educational programs and ICU bundles in increasing awareness of and preparation to assess and treat delirium. 20 We hope that the significant improvement in delirium assessment compliance we observed in this QI study will lead to better detection and management of pediatric delirium. Future work should assess the clinical implications of this project—specifically, how increased accuracy in delirium screening may lead to more timely diagnosis and treatment for patients with delirium.…”

“…The significant role of EMR-based interventions in quality improvement in hospital settings in general, and ICU in particular, has been widely demonstrated. 16 – 18 This quality improvement project contributes to the existing literature by showing that one EMR-related intervention, introducing protocol flowsheets, improves compliance with delirium assessments. Future studies might focus on additional interventions that introduce newer automated systems into EMRs to aid healthcare professionals in conducting and documenting easily and efficiently.…”

The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance

“…Other research has demonstrated the effectiveness of data feedback both through audit-and-feedback mechanisms and through specific use of tailored electronic health record tools [ 30 , 31 , 32 , 33 ]. Notably, the combination of health record tools and systems redesign approaches have worked in other clinical areas [ 34 ]. However, none of these approaches are effective if they are not acceptable to clinicians and utilized in practice.…”

A Systematic Literature Review of Six Sigma Implementation on the Automotive Component Industry

“…Six Sigma is a form of quality improvement towards the target of 3.4 defects per million opportunities (DPMO) for each product, both goods and services reduce the number of defects. Six Sigma can also be defined as a business process improvement method that aims to find and reduce the factors that cause defects, reduce cycle times and production costs, increase productivity, meet customer needs, achieve optimal machine utility, and get better results [9]. Both in terms of production and service.…”