Challenges in Content Review
Healthcare organizations face many demands to coordinate the review of content by various staff. For example, processes intended to incorporate new guidelines or policies into practice such as Clinical Practice Guidelines (CPG) need the right experts in the organization to review, reconcile, and implement changes based on the guideline. Similarly, training processes often require staff to review policies or educational content. With the limitations of infrastructure in many organizations these processes often rely on emails, meetings, printed content, spreadsheets, and project leader outreach.
Common challenges in content review:
duplication of work,
difficulty involving all the right staff in a timely manner,
cumbersome sharing of instructions,
Opaque review processes you can’t easily check in on, and
bottlenecked processes that only one person can contribute to at a time.
Coordinating Digital Content Review using Qualaris Cards
Qualaris streamlines content reviews through Improve’s Cards feature. Cards are digital workspaces that can be flexibly used to coordinate everything from plans to task to ideas and more. Learn more about Cards here.
Cards have a few particularly helpful features specific to content reviews:
Card Description - use the Description to add instructions or context to a card and to embed hyperlinks to online content
Card Tasks - use Tasks to assign and track the completion of specific review tasks by staff
Card Attachment - use Attachment to place any important documents or files right on your card for easy access by staff
Card Comments - use Comments to capture important review feedback from staff and to facilitate discussion on the topic (similar to an email or online forum)
Card Activity - use Activity to see a historical record of all comments and key Card events to stay up-to-date or to generate a historical record documenting the completion of a review process
Froedtert & The Medical College of Wisconsin
Kristi Opper, MS, RN, ACNS-BC, Clinical Nurse Specialist; 8NT
Holly Pollex MSN, RN, Clinical Content Lead, Clinical Informatics
MaryAnn Moon, MSN, APRN, ACNS-BC, APNP, Director of Advanced Practice Nursing
A review process is mandated for incorporating updated Clinical Practice Guidelines (CPGs) into Froedtert’s Electronic Health Records. This periodic process requires hundreds of CPGs to be reviewed by specific experts across the enterprise in order to incorporate the guidelines into Froedtert’s policies while generating a record for accreditation purposes. Previously, the review process required significant staff time due to the limitations of the available infrastructure (email, sharepoint, spreadsheets) for project coordination and documentation.
A pilot project was proposed to streamline CPG Reviews using the quality improvement software Qualaris. Qualaris’ internet-based offers a number of useful tools for data collection, analysis, project management, and digital collaboration organized in a single platform.
Previous CPG Review Projects were reviewed to identify major opportunities for improvement. Project success criteria were defined prior to implementation targeting these opportunities.
Note - this project was carried out using an earlier version of Cards called Opportunities, which featured all the described functionality shown here. However, screenshots here feature the updated feature.
A high-level plan was developed to map the various collections of CPGs provided by Elsevier into Qualaris improvement projects that would facilitate the process of assigning, accessing correct CPG content, and contributing required review comments.
Step 1, Set up Qualaris projects - Qualaris’ digital improvement projects are set up to organize the review of each CPG collection (e.g. inpatient, emergency department, etc.)
Step 2, Set up CPG content for review - Each CPG (provided online by Elsevier) is set up for review in Qualaris by combining everything needed into digital workspaces called “Cards” in Qualaris. Each Card represents one CPG and includes within it a link to the online CPG content, rationale/notes, and reviewer instructions
Step 3, Assign CPGs to staff - Each Card is assigned to specific staff for review
Step 4, Staff complete reviews online - Staff see what they’ve been assigned and can open each Card to access all the info they need and add comments to complete their review
Step 5, Project leaders track progress - Project leaders can track progress in real-time and address issues. When a CPG review is done, the project leader archives the Card.
Step 6, Qualaris archives everything - After all CPGs are reviewed, Qualaris generates an indexed PDF file of everything for archival purposes
CPGs were grouped into smaller collections as Qualaris improvement projects. The following figure shows how some of these Qualaris improvement projects that were set up for different CPG collections.
CPGs were automatically uploaded into Qualaris Improvement projects with the assistance of Qualaris support using the Cards feature. Within Qualaris, Cards serve as digital workspaces for plans, tasks, and ideas that allow many users in the organization to collaboratively work together. Shown below is a list of Cards set up to organize the review of individual CPGs within the Inpatient collection.
Each Card included review instructions and a link to hosted CPG content provided by a secondary vendor in the description. Reviewers were added as Card Members for their assigned CPGs. Reviewer feedback was captured as comments on the Card. Shown on the next page is a representative Card for a specific CPG. Near the top, the link to the actual CPG content and instructions are displayed. At the bottom reviewer’s comments are captured.
Approximately 100 reviewers were provided instructions via an email and short training video and given access to Qualaris through email-associated accounts. Optional webinar training was offered and taken up by ~25% of participants.
Reviewers could see which CPGs they were assigned using the Qualaris Notifications feature. Clicking an assigned CPG automatically took them to the Card. Shown on the following page is an example of what the Notifications page looked like for an individual reviewer assigned some CPGs. In this case, they were assigned 3 CPGs related to the topic of “Wound (Includes Pressure Injury”.
Project leaders marked CPGs done when the review process was completed by archiving the Card.
Project leaders tracked progress in moving CPGs from the Open to the Archived state. Shown below is an example of the reviewed Cards for the Inpatient collection shown in the project’s list of Cards. The “127 Open” represents 127 CPGs that haven’t yet been marked completed by the project leader while the “305 Archived” represent the CPGs already archived by the project leader after completion of the review process.
When the project was completed, Qualaris Support assisted in exporting all of the content including each Card and the reviewer’s comments into an indexed PDF. This PDF was stored locally for archival purposes.
Discussion & Conclusions
The CPG project was significantly enhanced for project staff and reviewers through the use of digital collaboration tools in Qualaris. Along with efficiency gains, the approachable digital nature of this year’s review process allowed more participants from different parts of the enterprise to contribute. We also observed examples of discussion amongst reviewers enabled by the transparent and real-time nature of captured comments on each CPG. One learning for future improvement was that more, smaller Qualaris improvement projects (as opposed to just 6) would make it easier to manage the work. Members of Qualaris improvement projects receive Notifications for all activities across all CPGs within, and the high number made parsing these updates challenging.
If you’re interested in applying Qualaris to a content review project and you’d like some help, contact the Qualaris team using our support chat or by emailing [email protected]. We’d love to help you get started!