title: Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.
abstract: Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy.
  
  
  
  We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow.
  
  
  
  These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort.
  
  
  
  We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs.
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Jaishree
authors.initials: J
authors.lastname: Narayanan
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Sofia
authors.initials: S
authors.lastname: Dobrin
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Janet
authors.initials: J
authors.lastname: Choi
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Susan
authors.initials: S
authors.lastname: Rubin
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Anna
authors.initials: A
authors.lastname: Pham
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Vimal
authors.initials: V
authors.lastname: Patel
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Roberta
authors.initials: R
authors.lastname: Frigerio
authors.affiliation: Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Darryck
authors.initials: D
authors.lastname: Maurer
authors.affiliation: Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Payal
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Health Information Technology, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Link
authors.affiliation: Research Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Shaun
authors.initials: S
authors.lastname: Walters
authors.affiliation: Research Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Chi
authors.initials: C
authors.lastname: Wang
authors.affiliation: Research Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ji
authors.affiliation: NorthShore Neurological Institute, NorthShore University HealthSystem, Evanston, Illinois, U.S.A.
authors.forename: Demetrius M
authors.initials: DM
authors.lastname: Maraganore
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D004282:Documentation / Q000379:methods* / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology
keywords: Best practices; Clinical decision support; Electronic medical record; Epilepsy; Outcomes; Pragmatic trials; Structured clinical documentation support