A Standardized EHR Discharge Documentation Tool to Mistake‐Proof CHF Bundle Compliance

1Virginia Mason Medical Center, Seattle, WA
2Virginia Mason Medical Center, Seattle, WA
3Virginia Mason Medical Center, Seattle, WA
4Virginia Mason Medical Center, Seattle, WA
5Virginia Mason Medical Center, Seattle, WA
6Virginia Mason Medical Center, Seattle, WA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 167


In 2005, CMS and JCAHO implemented the Heart Failure Core Measures Set along with other core measures, in launching their hospital Performance Measures Initiative. Virginia Mason Medical Center (VMMC) has been able to improve heart failure core measures in their own Institution bul has struggled to reach and maintain 100% compliance. VMMC has had an EHR since Ihe 1980s and implemented online documentation in 2003, in part because it provides the organization with the capability to standardize clinical processes.


To design and implement a standardized documentation tool within the Electronic Health Record (EHR) that would improve user compliance with CMS and JCAHO core measures for heart failure.


VMMC's heart failure bundle compliance ranged from 30% to 60% wrien the core measures were initially implemented. A handful of clinical content experts, administrative personnel, and data managers were initially charged with improving our heart failure bundle compliance. Early on, efforts focused on identifying heart failure patients and creating lists used to provide feedback to providers. Despite efforts to educate, communicate, measure, and report, the compliance rale was only increased to 85% by 2008. Compliance barriers included lack of standard heart failure definitions, inability to readily collate information in one location within the EHR, and lack of visual cues, prompting providers to complete and update the heart failure bundle. Development of a standardized documentation tool challenged innovators To provide clear definitions, allowed automation and collation of data that could be easily seen and utilized. Embedding the tool in discharge instructions provided visual cues that trigger providers to complete the heart failure bundle before patient discharge and makes it very easy to mistake‐proof the process. After the tool's initial implementation, il was not clear that it would improve compliance. Although the process and definitions became standardized, the amount of time needed to complete the tool made it onerous. Improved compliance eventually came after additional PDSA cycles on the template. These improvements included embedding views of the patients' medication lists, which saves the effort of toggling between windows of the EHR. Also, embedding diagnostic codes on the tool allowed the daily heart failure list to be created automatically rather than hy hand, as had been done previously. This saved 100 hours/year of physician time. VMMC now has a heart failure bundle compliance rate that has been at or very near 100% since July 2009.


Implementing a computer‐based heart failure discharge documentation tool was a key step in significantly improving user compliance with CMS/JCAHO treatment and documentation core measures at VMMC. Several modifications of the initial tool, through trial and error, were necessary.

Author Disclosure:

D. Hanson. Virginia Mason (VMMC), employment; L Duchscherer, VMMC, employment; S. Krevat, VMMC, employment; M. Ingraham, VMMC, employment; B. Aaronson, VMMC, employment, none: B. McDonald, VMMC, employment.

To cite this abstract:

Hanson D, Duchscherer L, Krevat S, Ingraham M, Aaronson B, McDonald B. A Standardized EHR Discharge Documentation Tool to Mistake‐Proof CHF Bundle Compliance. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 167. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/a-standardized-ehr-discharge-documentation-tool-to-mistakeproof-chf-bundle-compliance/. Accessed May 27, 2019.

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