Research Projects

Kathy Nuss, MD, is a member of the hospital multidisciplinary sepsis team that developed one of the most notable sepsis detection algorithms for pediatrics in the world. This system utilizes existing documentation in the electronic health record to identify patients at risk for sepsis and alert provider teams to take action. The sepsis screening tools have been so successful they are the standard of care in the Epic foundation system for pediatric hospitals around the world. 

Nationwide Children’s Hospital continues to cultivate our Situational Awareness efforts to focus on early recognition of patients at risk for clinical deterioration. Laura Rust, MD, in partnership with the Data Science team at Nationwide Children's, led the development and operationalization of a hospital-wide predictive model aimed to identify high-risk children for inpatient deterioration. Implemented in 2021, this deterioration risk index continues to demonstrate statistically significant reduction in patient harm while providing an earlier opportunity for risk mitigation.

The Clinical Informatics division co-chairs the Epic Medication Safety Committee to identify and mitigate potential safety issues with innovative solutions. We also participate in the Safer CDS in Pediatric Prescribing Taskforce (SCrIPPT), a multi-institutional collaborative that works with our EHR vendor to perform this function on a national scale and effect change.

Care standardization is essential for ensuring patients receive consistent, evidence-based care tailored to their specific needs. The EHR is one of the primary tools that can help provide real-time decision support to encourage adherence to Clinical Pathways and enhance communication among care teams. Dr. Laura Rust serves as one of the co-medical directors for the Clinical Pathways program, helping to oversee EHR tool development and outcome reporting. 

Leveraging patient entered questionnaires via tablets has helped in decreasing physician burden. Shravani Vundavalli, MD, Aarti Chandawarkar, MD, and Alysha Taxter, MD, have been instrumental in streamlining this workflow at Nationwide Children's. This includes providing standard patient screening tools (mental health, development etc) that are auto or manually assigned on tablet based on the visit type, auto scored and seamlessly presented to the provider at point of care with autoscoring and required clinical decision support.

Patient Allocation Dashboard for OSU Hospital Medicine designed by Drs. Gill and Yang as a part of their fellowship.

Health IT impact was created to complement the Ohio State University Wexner Medical Center's strategic framework. Clinical informatics fellows work with the Chief Health Information Officer (Dr. Tripathi) to identify best standards in healthcare technology and to further refine the medical center's approach to transforming health IT as part of this strategic plan.

Children with autism often have delayed diagnoses due to delays in identifying autism and connecting children to the appropriate resources. Dr. Vundavalli has worked on improving referral rates for children with high risk for autism in primary care settings with EHR based clinical decision support for identifying high risk patients and automation of appropriate referrals. 

Multispecialty clinics provide care for complex patients and involve physicians from multiple specialties seeing one patient in one visit. However, this can lead to confusion for patients, scheduling challenges for physicians, and data integrity issues. Naveed Farrukh, MD, developed a series of changes that link all physicians to a multispecialty visit. This helps patients understand all the physicians they are seeing, physicians organize their schedules, and the system data to more accurately reflect clinic effort.

The hospital problem list serves as an electronic handoff between hospital and primary care providers. This project aimed to increase the percentage of reconciled problem lists at discharge from 32% to 50%. We used behavioral economics strategies, such as keeping the problem list open by default and automatically adding it to the discharge summary with helpful guidance.

Fellow-Led Clinic Optimization

This is a longitudinal rotation where 2nd year fellows utilize their leadership and project management skills to develop tools and optimize EHR related workflows for ambulatory clinics. The first-year fellows function as builders during this rotation after completing Epic Builder certification. This is a fully fellow-led project with faculty mentorship provided to reinforce learning that started in 2021.

Clinics Optimized

• 2021: Foster Care Clinic – Shravani Vundavalli, MD and Manjot Gill, MD
• 2022: South High Primary Care – Emily Sentman, MD and Kate Tobin, MD
• 2023: Family AIDS Clinic and Education Services – Faraaz Chekeni, MD and Jason Lo, MD
• 2024: Type 2 Diabetes Clinic – Naveed Farrukh, MD
• 2025: Adolescent Medicine Med Management of Disorder Eating and Eating Disorders (MDEED) Clinic – Matt Grisham, MD and Oluwatoba Moninuola, MBChB, MPH

Jennifer Lee, MD, and Dr. Taxter lead the EHR optimization strategy for the Nationwide Children's Hospital WINS initiative, which focuses on fixing everyday EHR workflow frustrations. Their work includes using data to improve tools like speed buttons for diagnoses, notes, discharge education, and billing across all outpatient specialties. The team continuously looks for and removes these small but impactful issues.

Clinicians can highlight opportunities ripe for improvement but sometimes need assistance in developing the final EHR solution. Dr. Lee developed the Clinical Informatics Consult Service to improve EHR experiences for front line clinicians, help triage requests for the organization’s information services resources and operate as a continuous learning experience for CI fellows and informatics faculty.

Dr. Rust collaborated with over 50 medical specialties to develop customized Electronic Health Record (EHR) handoffs, significantly enhancing communication and care coordination. By engaging with diverse specialty teams, she identified unique workflow needs and information requirements for each discipline, ensuring that the EHR handoffs were tailored to capture critical patient information efficiently. This collaborative effort resulted in standardized, yet flexible, handoff templates that facilitated seamless transitions between care providers. The improved EHR handoffs not only reduced the risk of miscommunication but also ensured continuity of care, ultimately leading to better patient outcomes and increased clinician satisfaction.

Dr. Chandawarkar and Emily Sentman, MD, worked on a series of nudges including prioritizing in basket messages, sending biweekly automated outlook messages to providers when charts were open over 5 days and daily when over 21 days, creation of a dashboard for providers to see their performance and involving our HIM team for outreach. We were successfully able to reduce the number of charts open for over 30 days from over a 1000 to less than 20 within a year.

Dr. Chandawarkar worked on auto purging older messages in specific folders, deactivating folders and changing font color and flagging for messages that required provider attention.

Pediatric patients often get vaccines from different organizations. Dr. Lee was the champion for the initial effort to create a two-way connection with the Ohio Department of Health’s vaccine system. After that, it became even more important to match outside vaccine records with our hospital’s records. Now, Drs. Vundavalli and Juan Chaparro, MD, are leading a project to automate this vaccine reconciliation process using a combination of custom coding and Epic functionality.

Shama Patel, MD, has helped designed a neonatologist-specific patient summary report to streamline pre-rounding and improve in-round documentation efficiency. She has helped to standardize progress notes for all neonatologists using a single, rule-based template to minimize manual data entry and support compliant billing and coding. She also has improved accuracy of newborn race documentation by modifying the registration workflow to default to "guardian unavailable to ask" followed by direct family outreach, ensuring patient-reported data not transcription from the maternal history.

There is an ever-increasing demand to make EHR workflows available and optimized handheld devices. Drs. Rust and Lee partnered with clinicians to enhance user interface design, streamline data review, and focus on intuitive navigation within EHR mobile apps. Putting patient information, ordering capabilities, and communication tools at provider's fingertips leads to improved workflow efficiency and patient care.

Dr. Chaparro leads the intrusive alert team at Nationwide Children's. His team developed a feature that lets users give quick feedback on alerts using thumbs up or down links. This feature is now visible across all Epic organizations and on the Epic UserWeb. A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week.

Drs. Chandawarkar and Sentman created EHR solutions to help improve patient experience, specifically that clinical services would be able to respond to patient messages within 2 business days.

Dr. Vundavalli worked on integration of Epic Population Health Tools to help with claims and external data mapping into the HER. This has assisted in accurately capturing HEDIS and CPC measures for Ohio Medicaid patients and support quality care initiatives and identify CareGaps.

Drs. Vundavalli and Taxter worked on standardizing referral workflows and work queues across the hospital. The referral redesign project also supports bidirectional referral workflow for referrals from outside organizations and allows for secure communication and messaging with outside providers.

Dr. Vundavalli collaborated with the Patient Experiences team to ensure Spanish speaking patients had the validated translation for developmental and mental health screenings available in Spanish both in clinic and through MyChart. This has decreased time administering questionnaires reducing both nursing and interpreter time needed and improved clinic workflows.

Dr. Vundavalli has helped implement standardized patients' statuses across the hospital to ensure appropriate signaling of patient visit statuses and necessary events in order to complete outpatient patient visits ensuring safe discharges for patients needing to see multidisciplinary team members during their visit. This has helped increase data collection on visit metrics in order to capture opportunities for improvements in clinic flow.