Team is brain: Leveraging EHR audit log data for new insights into acute care processes

Abstract

Objective: To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes. Materials and Methods: We selected one widely-used process outcome: emergency department (ED)-based team time to deliver tissue plasminogen activator (tPA) to patients with acute ischemic stroke (AIS). We evaluated Epic audit log data (that tracks EHR user-interactions) for 3052 AIS patients aged 18+ who received tPA after presenting to an ED at three Northern California health systems (Stanford Health Care, UCSF Health, and Kaiser Permanente Northern California). Our primary outcome was door-To-needle time (DNT) and we assessed bivariate and multivariate relationships with six audit log-derived measures of treatment team busyness and prior team experience. Results: Prior team experience was consistently associated with shorter DNT; teams with greater prior experience specifically on AIS cases had shorter DNT (minutes) across all sites: (Site 1:-94.73, 95% CI:-129.53 to 59.92; Site 2:-80.93, 95% CI:-130.43 to 31.43; Site 3:-42.95, 95% CI:-62.73 to 23.17). Teams with greater prior experience across all types of cases also had shorter DNT at two sites: (Site 1:-6.96, 95% CI:-14.56 to 0.65; Site 2:-19.16, 95% CI:-36.15 to 2.16; Site 3:-11.07, 95% CI:-17.39 to 4.74). Team busyness was not consistently associated with DNT across study sites. Conclusions: EHR audit log data offers a novel, scalable approach to measure key contextual factors relevant to clinical process outcomes across multiple sites. Audit log-based measures of team experience were associated with better process outcomes for AIS care, suggesting opportunities to study underlying mechanisms and improve care through deliberate training, team-building, and scheduling to maximize team experience.