STANDARDIZING IV TO SQ THERAPY TRANSITIONS IN IBD CARE: IMPLEMENTATION OF AN EPIC SMARTFORM TO STREAMLINE WORKFLOW AND REDUCE COMMUNICATION BURDEN IN IBD CLINIC

Abstract BACKGROUND Biologic therapies for inflammatory bowel disease (IBD) often require intravenous (IV) induction followed by subcutaneous (SQ) maintenance. The transition from IV to SQ therapy is complex and frequently delayed due to fragmented non-standardized workflows and manual tracking of prior authorizations (PA), scheduling, and prescribing. At Ochsner Health’s IBD Clinic, clinic-based pharmacists previously relied on spreadsheets and electronic health record (EHR)-based communications, contributing to significant documentation burden and inefficiencies. Structured EHR tools, such as SmartForms, can support patient care coordination, by standardizing documentation, reducing reliance on manual communication, and streamline clinical workflows. To address these challenges and establish a standardized workflow, the clinic implemented an EPIC SmartForm in May 2025 to standardize tracking of PAs, infusion scheduling, and prescribing for IV to SQ transitions. METHODS The SmartForm was embedded in EPIC to capture key data elements related to medication status, PA approvals, infusion timing, and SQ prescribing. Data were collected on IBD patients who underwent IV to SQ transitions between May and September 2024 (27 records pre-implementation) and March and August 2025 (30 records post-implementation). Outcomes assessed included communication burden (number of EPIC InBasket messages), time from IV PA to first infusion, and perceived utility of the standardized tool. RESULTS Implementation of the SmartForm standardized communication and documentation, reducing the need for InBasket communications to track patient status (13.7 vs. 8.8 per patient). The average number of days from IV PA approval to the first infusion was similar pre- and post-implementation (19.1 vs. 22.8 days), many with significant delays outside of the provider’s control (e.g., denials, processing time for patient assistance programs, patient refusals, patient health status). On average, SQ approval occurred within a day post-implementation compared to approximately 5 days pre-implementation. Overall, the three pharmacist users felt the SmartForm was easy to use and helped track IV to SQ transitions, with mean scores of 4.0 on a 5-point Likert scale. It was noted that it would be helpful if the SmartForm documented the use of and processing times for those who receive medications through patient assistance programs. CONCLUSION Implementation of a structured EPIC SmartForm standardized the tracking process for IV to SQ therapy transitions, reducing communication burden with a user-friendly form. Standardized EHR-based tools may be an effective strategy to reduce workflow variability, enhance efficiency, and improve coordination in specialty medication management. They could also be adapted for use in other specialty clinics.