Clinical pathways innovation: A lesson on the value of clinician based feedback and collaboration with Flatiron Health.

Abstract

1578 Background: Clinical pathways have emerged as a strategy to provide value-based care by reducing treatment variation across oncology practice. Despite evidence for cost reduction and improved patient outcomes, adoption of clinical pathways has met resistance in the oncology community given concerns regarding the impact on workflow, and cost. Flatiron Assist, an EMR based pathways tool, is a promising solution to minimizing workflow friction by proving a novel, streamlined user interface. Methods: The Abramson Cancer Center at the University of Pennsylvania and Flatiron Health conducted a pilot study from August 2021-December 2022 to test the use of Flatiron Assist within its thoracic oncology practices. The goal of the pilot was to increase utilization as well as usability of the pathways tool over time through clinician and developer iterative collaboration. Penn’s clinical pathways were incorporated into the tool and integrated into the EMR. An education program trained clinicians on the tool’s functionality. Based on clinician feedback, the Penn team identified two areas of improvement for the tool: speed and organization of the tool keys and prompts. Changes made over time included: 1) increasing the speed of the tool 2) restructuring the organization of keys and prompts, and 3) creation of a “hot button” for three common clinical scenarios in order to increase efficiency. Speed of the application (session length in seconds), utilization of the hot button (number of sessions/overall sessions) and overall physician adoption (treatment ordering with Flatiron Assist/total thoracic orders) were calculated during the pilot. Results: Provider utilization of the pathways tool increased over time with a baseline adoption rate of 29% in August 2021 and a peak of 74% in April 2022. Median session length decreased over time from 106.4 seconds (August 2021) to 39.9 seconds (December 2022). Peak performance for session length was 38.2 seconds (November 2022). Usage of the hot button introduced in August 2022 has increased over time from 27.6% of sessions to 41.8 % in November 2022. Thoracic providers ordered, on average, 1.7 new treatment plans per week, resulting in less than 1.5 extra minutes of work per week with optimal use of the pathways tool. Conclusions: Collaboration between Penn and Flatiron Health effectively reduced specific areas of friction associated with the use of Flatiron Assist. Changes made to the speed, button organization and functionality of the tool contributed to increased clinician utilization over time. Future development of EMR based pathway tools should incorporate clinician engagement and feedback.