Measurement of Clinical Documentation Burden Associated With Tracking Immunology-Related Products Requiring Intravenous Induction and Subcutaneous Maintenance

Background:
Biologic treatments for immunologic conditions often require an intravenous (IV) induction followed by subcutaneous (SQ) maintenance therapy. Transitioning from IV to SQ therapy can be complex, leading to delays in therapy. Electronic health records (EHR) tools are commonly utilized to improve patient care coordination, reduce medical errors, and support clinical decisions to improve patient outcomes. We conducted a study to quantify the documentation burden related to tracking prior authorizations (PAs), and scheduling IV administrations and prescribing SQ therapies, and to evaluate the potential benefits of implementing a structured EHR tool.
Methods:
The current tracking process at Ochsner Health’s (Ochsner) inflammatory bowel disease (IBD) Clinic involves using Excel spreadsheets and EHR-based communications to monitor the status of the prescriptions, PAs, and treatment schedules for IV and SQ. We conducted a retrospective analysis the logs and EHR communications from May 2024 to August 2024, focusing on the number of patients, volume of communications, and the time associated with documentation efforts. Additionally, we applied time to each communication to quantify the documentation effort associated with the current process.
Results:
During the study period, 27 patients with IBD were initiated on treatment requiring an IV induction dose before starting SQ maintenance dose. The clinic-based pharmacist sent an average of 13.7 EPIC InBasket messages per patient regarding PA approvals, scheduling, and related tasks. The average time from IV PA approval to the first dose was 19.1 days. Delays in initiating treatment were attributed to various factors, including denials (5 patients), patient health status (7 patients), and patient refusals or non-response (3 patients). Although most patients received SQ approved before their IV approval, 5 patients experienced delays, with SQ approval occurring an average of 4.8 days after the IV approval.
Conclusions:
The current process at Ochsner for managing the transition from IV to SC therapy is fragmented, placing a significant documentation burden on clinical staff. The findings underscore the need for a more streamlined and standardized approach, such as a structured EHR form. Implementing such a tool could reduce documentations efforts and ensure appropriate clinical staff have visibility into the patient’s medication status, potentially reducing delays in treatment initiation.