This really encouraging article appeared last week.
EHR-Integrated Tools Help Improve Chronic Kidney Disease Care
Treatment involving EHR-integrated tools and patient engagement strategies are effective in improving areas of chronic kidney disease care.
By Kate Monica
April 05, 2018 - A quality improvement program combining EHR-integrated tools and patient engagement strategies can significantly improve quality of care for patients with chronic kidney disease, according to new research published in the American Journal of Managed Care (AJMC).
Over a one-year period, Sequist et al. observed 153 primary care physicians treating 3,947 high-risk patients and 3,744 low-risk patients with stage III chronic kidney disease across 13 ambulatory health centers at Harvard Vanguard Medical Associates in Massachusetts.
As part of the study, participating physicians received a set of EHR-integrated alerts through the practice’s Epic EHR system during office visits. These EHR alerts provided physicians with recommendations for risk-appropriate chronic kidney disease care.
When treating high-risk patients, physicians received EHR alerts recommending a referral to a nephrologist if the patient had not visited the specialist in the past 12 months.
Physicians treating high-risk patients also received an EHR alert recommending specific prescriptions if the patient had a diagnosis of hypertension or albuminuria and had not been prescribed the medications in the last year.
For low-risk patients, physicians received prescription recommendation alerts as well as alerts suggesting certain overdue lab tests.
Meanwhile, participating patients received educational materials by mail providing treatment recommendations based on information gleaned from their EHRs. Mailings ranged from reminders to request overdue lab tests and follow-ups to educational materials about current medications.
Ultimately, researchers found low-risk patients who had participated in the quality improvement program were about 25 percent more likely to have received urine microalbumin testing than patients not enrolled in the program.
Additionally, participating high-risk patients were over 10 percent more likely to have seen a nephrologist in the past 12 months than those not enrolled in the program. Furthermore, both high and low-risk patients enrolled in the program showed higher rates of annual testing for vitamin D, phosphorus, and parathyroid hormone than those who did not participate.
“In a large randomized controlled trial of patients with stage III CKD, we demonstrated that a quality improvement program consisting of electronic decision support combined with mailed patient self-management support tools significantly improved quality of care, including use of nephrology referrals and laboratory testing,” stated researchers in the report.
Researchers emphasized the effectiveness of patient engagement among patients with chronic kidney disease. The team noted a substantial portion of study participants had not been informed of their disease prior to the study, and stressed the importance of ensuring patients are aware of their diagnoses.
More here:
Whoopee do I thought reading the headline. Yes the use of an EHR (with disease specific interactive clinical decision support) – along with a personalised interactive patient education and interaction – did make a difference as you might expect.
The problem for us here in OZ is the majority of Digital Health Funds are being spent on a system that is incomplete, seemingly inaccurate and does not support interactive clinical decision support for anything.
Maybe if even a tenth of the funds being spent on an incomplete health data vacuum cleaner was spent where the evidence says you can make a difference – at the point of clinical care – digital health might get somewhere. Right now it is heading into the headlight of an oncoming train trying to see what to do next!
David.
18 comments:
David, readers. I believe the following HIMAA price sums up the risk of ADHA and its leadership and workforce preparation
http://himaa2.org.au/sites/default/files/Digital_Health_Action_Stations_V2_2.pdf
When you cannot distinguish between data, information and metadata, or appreciate what it takes to manage all this, perhaps they are in the wrong industry. I feel for the clinical folk working with ADHA it must be a challenge.
8:27 AM. That is a worry
and if I could add...
there is more to data in the health care system than just patient data,
and
there is more to health care than just data - there are many, many processes.
I wonder if they know what a patient is?
This is quite serious, if this reflects the capability within ADHA then is raises some very serious clinical safety concerns, intellectual ownership risks and definitely massive concerns around security of information.
This is suppose to be a national body in charge of some of the most private information of Australians. The fact they can not determine what is what rings massive alarm bells.
That to one side I fully support HIMAA in their requirement for health information managers.
I am not sure you could make this fiasco up.
The HIMAA submission riases the question of just what the board and chairperson are doing. The board clearly contains persons with some degree of understanding in this domain. The framework for action represents a rather important national component, one that much funding and business planning will be anchored in. Either the Board has paid little attention to this, or it represents a waste of time and is seen as little more than shelfware. The other alternative is the Board is not fit for purpose and are perhaps negligent in the obligations to the Australian public, industry and the healthcare community.
It would also appear the CEO many years wandering around in health IT has not even learned the basics concepts. Which begs the question - does he understand anything than he proclaims to be a thought leader in?
True - information management doesn't seem to feature in the 'Australian Digital Health Agency.' It wants to digitise health, not health information. Otherwise it would be the 'Australian Digital Health Information Agency'. It's all about mobile apps, digitised screen buddies, colourful websites, soundbites and a deep hatred of the fax machine. Lots of talk about foundations, with little understanding of the critical need for health information management as a core foundation.
Well done HIMAA for standing up to the glossy strategy. However, sadly, I don't think they will read or understand your response.
The comments in this thread are a little over the top,. I don't agree at all with HIMAA's use of the term 'metadata' - it's completely not consistent with the IT industry as a whole. Their differentiation between data and information might not be inconsistent with the general interpretation, but there's hardly widespread consensus on this. Whatever, I don't see these comments as particularly germane to a high level strategy document which is concerned with all forms of data|information|whatever, and completely don't justify the conclusions drawn here.
Nor does failing to mention one particular set of stakeholders by name invalidate the strategy document, whether or not they are critical to the success of whatever action might be proposed.
Quite agree with 10:52 AM. Nothing wrong with summing things down, not stipulating meaning or even forgetting people and professions. After all it is healthcare, after all medicine is just some stuff to make you feel better pressed in chalk.
I not sure I fully agree with you Grahame. Health information managers are hardly a fringe group. Under user centric design surely they should be a little more front and centre, after all they know a thing or two in this domain.
If the framework for action was some internal IT project brief such errors might be overlooked. However this is suppose to be a national plan to implement a Strategy. I would expect a bit more rigour and polish. In your world it is akin to sloppy coding
Well, I didn't say they were fringe. Just that they were a particular stakeholder. I guess, looking at the strategy again, it might be good to have mentioned HI managers in "To support these expectations, clinicians and healthcare providers need ongoing training, as well
as high-quality and reliable digital health technology, clinical information systems and internet connections, to ensure that they are able to use digital health technology and services effectively." But since the document doesn't set out to enumerate all the stakeholders, I really can't see that this is a big deal with regard to the strategy. Perhaps you might argue that you can't have a national strategy without first of all enumerating stakeholders - is that normal in a national strategy? Is it a defect in the strategy that it doesn't? I think there's other areas of more significant discussion that this.
Fair call on a quibble. But understanding and articulating the market and the players in any market is important. It is a broad market so nothing wrong with articulating these in full. Not recognising actors my result in the stimulation of dark constraints in the future.
Agree with Grahame. And further, the HIMAA have done their membership no favours, they have not actively promoted the skills, knowledge and possible contributions their members might make; they declined to amalgamate or partner (or whatever) with HISA; they are nowhere to be seen at mainstream e health (or technical) forums/events/venues; they have done little to encourage change and re-skilling among their membership/workforce and therefore remain somewhat of a 'niche' stakeholder. What goes around....
6:05AM. You and Grahame are both correct. HIMAA is not toeing the party line and embracing the MyHR, unlike yourselves they refuse to turn a blind eye and refuse to roll-over. Fortunately there are sufficient numbers of colleges and peak bodies and others locked in that entity such as HIMAA can be dismissed.
"Fortunately there are sufficient numbers of colleges and peak bodies and others locked in that entity such as HIMAA can be dismissed."
I seriously doubt that is even close to true....
David.
Absolutely agree David. I am not sure what is meant by 6:05 AM in regards to mainstream events etc... HIMAA is hardly invisible. Without clarification it leaves me thinking all sorts of concerning thoughts. Unless you turn up waving the right flags are you relegated to the outhouse? I am hoping it has not come to that.
Personally I think HIMAA have done a great service to there members and profession and the broader community. Having read through a few submissions the HIMAA contribution I thought was very well written and made for both an informative and pleasant read.
From last year
http://www.himaa.org.au/2017/proceedings/presentations_2017.htm
(and sure... the depth and breadth might not be apparent on this program link only) BUT..
Any mention of prominent e health initiatives or work programs (and no, I don't mean MyHR) Anything other than hospital based data/information? Anything other than WHO products or national/jurisdictional secondary data instrumentation? How about GP/Primary care, Allied Health, Pharmacy, Pathology, Radiology, private (specialist) practice data? Anything about EMR design, roll-out, support? Anything about modelling of clinical workflow? clinical decision support? Anything here about secure messaging, HL7, FHIR? How about data extraction methods, real-time data dashboards? patient data portals and apps? Anything about semantic or functional interoperability?
I have looked at the link and the contents make perfect sense to me given what Health Information Managers do and are interested in. No one is suggesting they are omniscient Health Informaticians! But they are a stakeholder in the management of a lot of patient information and its coding, storage and quality etc. Important stuff in my eyes....
David.
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