Charting Software System Accuracy

After it was determined that a QI project would be implemented to improve STD charting, the SCHD QI council assigned two trained council members to facilitate the QI project. The facilitators met with the staff member who nominated the QI project and the clinical services coordinator to complete the QI team charter. All STD team clinicians and the team's community health intervention specialist were included as QI project team members. The facilitators established two meeting dates to complete the project's planning phase. During these team meetings, the STD team reviewed the error data gathered by the STD team leader. From these data and group discussion, the team developed an aim statement that established a goal: No more than 10% of charts reviewed by the STD team leader would have errors during the pilot project period—May 2, 2017, through May 12, 2017. To fully understand charting errors within the Practice Fusion STD software system, the team completed a flowchart of data entry steps within a client chart in Practice Fusion. The steps in the flowchart reflected the exact steps in the Practice Fusion system. This process highlighted steps in the data entry process that varied among clinicians. It also brought to light confusion about various steps of the data entry process. Once the STD team members agreed on the flow of the data entry process, they completed a root cause analysis using a fishbone diagram. This analysis resulted in two root causes for charting errors. Based on the results of the root cause analysis, staff brainstormed possible solutions for improving charting errors within Practice Fusion. The solutions were gathered in an affinity diagram to group similar solutions. The team determined that the following types of solutions would be made: (1) adjust templates within the Practice Fusion software, (2) reduce duplication within data entry in Practice Fusion and other STD program reporting forms, and (3) add a step in the STD charting process to include a documentation quick guide and checklist. A timeline was created to pilot the proposed changes for a 2-week time frame. Staff members were assigned duties to implement the identified solutions. A “check” meeting was scheduled to bring the team and facilitators back together to measure data, discuss successes and opportunities for further improvement, and decide on how to proceed with standardizing the potential improvements.

The team selected documentation errors in completed Practice Fusion charts as the primary measure for the project. Data were compared from before improvements were implemented to after improvements were implemented. The STD team leader tracked these data weekly and monitored them on an Excel spreadsheet.