Application of the Consolidated Framework for Implementation Research Model to Design and Implement an Optimization...

Area of Science:

• Health Informatics
• Healthcare Management
• Implementation Science

Background:

• The COVID-19 pandemic disrupted electronic health record (EHR) adoption at Columbia University Irving Medical Center (CUIMC).
• Resources were reallocated, hindering initial EHR system implementation.
• A structured approach was needed to improve EHR utilization.

Purpose of the Study:

• To develop and implement an optimization methodology for enhancing EHR utilization.
• To address workflow challenges exacerbated by the pandemic.
• To leverage the Consolidated Framework for Implementation Research (CFIR) for systematic improvement.

Main Methods:

• A two-component methodology: qualitative/quantitative data analysis and frontline staff engagement in workgroups.
• Workgroups mapped current workflows, designed/implemented interventions, monitored effectiveness, and scaled changes.
• Utilized the CFIR framework to guide the optimization process.

Main Results:

• Significant improvements in clinical and operational workflows within the pilot department.
• Operationally: 20% increase in patient portal enrollment, 25% increase in schedule utilization, 19% reduction in check-in time.
• Clinically: Statistically significant increases in dictation and NoteWriter tool usage; improved SmartTool and dictation note composition compared to a control department.

Conclusions:

• The CFIR-referenced methodology effectively supported organizational optimization by addressing inner and outer settings.
• The strategy proved successful in identifying opportunities and implementing scalable interventions.
• Phase-1 data indicate a viable process for sustained organizational improvement in EHR utilization.