Company profile
Ozarks Healthcare is a not-for-profit medical center serving south-central Missouri and north-central Arkansas. The organization includes a 114-bed acute care hospital, family medicine and specialty clinics, and complete rehabilitation and home care services.
The challenge
Like many provider organizations across the country, meaningful problem list use at Ozarks Healthcare has been sparse. All providers, with the exception of those in the emergency department, are required to include at least one diagnosis on the problem list and historically few have gone above and beyond that minimum. Those who did add to the problem list — specialists in particular — did so with little regard for what was already documented, leading to unnecessary and duplicative entries and a great deal of frustration for primary care physicians (PCPs).
In an effort to maintain accurate medical histories and keep active problem lists clean, Ozarks Healthcare aimed to have problem lists cleared of the diagnoses that were acute during a given hospital stay upon discharge from the inpatient setting. However, hospitalists would often reconcile all of the active problems off the list, causing headaches for PCPs down the road. Between repetitive additions and unnecessary deletions, PCPs couldn’t rely on an accurate problem list from visit to visit. Adding to the confusion, the problem list was displayed by default in chronological order, not alphabetically.
The solution
At the beginning of 2020, Ozarks Healthcare went live with a new electronic health record (EHR) system. For about nine months, organizational problem list adoption and use were great, but those gains soon evaporated amidst the stress and chaos of COVID-19.
So, when Priscilla A. Frase, MD, Chief Medical Information Officer at Ozarks Healthcare, discovered that IMO Core was being offered to potential early adopters, she seized the opportunity to simplify problem list management, allowing physicians to display that important information grouped by clinical categories. “I knew that if I could get something like that it would give me an opportunity to reengage my providers around problem lists.” Frase wasn’t disappointed.
Upon activating the categorized view of the problem list for their 90 providers, 88 started using it immediately. (Only two asked to revert to the traditional list, one of whom reached out later that day to insist Frase turn categories back on.)
“It was really just amazing what such a simple change could do in terms of being able to rapidly process clinical information about the patient from a problem list in a matter of seconds,” said Frase. “It’s just much easier to clean up a problem list with the categorized view because you clearly see all the duplicates. You can also more readily see what diagnoses are not on the problem list by looking at the medication list, for example.”
It’s just much easier to clean up a problem list with the categorized view because you clearly see all the duplicates.
Early success and greater adoption
Since implementing IMO Core, Frase has noticed many of the organization’s problem lists are cleaner and contain fewer duplicates, which is good news all around.
“In the inpatient setting, when those moments matter – when a patient codes on the floor – I can quickly see what diagnoses that person has by jumping straight to those cardiopulmonary and kidney sections. Everything I need to know I can get in a matter of seconds rather than having to invest that brain energy to sort out what is always a convoluted mess. It’s suddenly not convoluted anymore,” she said. “It just makes sense.”
And the reception to IMO Core has been positive across the board from primary care to cardiology to orthopedics. “They really love the view. Specialists like being able to have their diagnoses, their specialty, at the top of the list where they can clearly see them,” said Frase. “With the IMO Core enhancement, we are closer to the ideal problem list. Plus, in IT, where we don’t often experience positivity in implementing EMR changes, there was no pushback.”
In addition to adopting the categorized view for the problem list, Frase is now exploring ways to partner with IMO to bring better organization and greater usability to other parts of the patient chart.
