Enhancing EHR Usability for Children With Medical Complexity Using a Structured Summary Tool

Children with medical complexity (CMC) require multidisciplinary care and generate extensive, fragmented electronic health record (EHR) data that make medical record review difficult and time-consuming. We aimed to develop a Medical Complexity Summary to support information retrieval for clinicians caring for CMC and hypothesized that the summary would improve usability of the EHR for medical record review of this patient population.

We conducted a mixed-methods evaluation at a large tertiary children's hospital. A multidisciplinary team iteratively designed the Medical Complexity Summary using stakeholder input. After implementation, we extracted usage metrics including unique users, encounters, patients, and encounter characteristics. A follow-up REDCap survey assessed usability among clinicians who reported using the tool, using 6 items from the National Usability-Focused Health Information System Scale and 1 original satisfaction question. Usability and satisfaction ratings were compared with preimplementation survey data.

During the first 5 months, 257 users accessed the tool across 1010 encounters involving 973 patients. Most uses occurred during inpatient encounters. Survey response rate was 36% (60 of 167), and 40 respondents (67%) reported using the tool. Compared with preimplementation data, users reported significant improvements in 4 of 6 usability domains and higher satisfaction with medical record review for CMC (P < .001). Ratings did not change for data completeness, timeliness, or physician-to-physician communication.

Early evaluation demonstrates strong adoption and improved usability associated with the Medical Complexity Summary. This structured EHR summary may reduce information-retrieval burden and support safer, more efficient care for CMC.