Point of Care Decision Support Point of Care Blog

Overview of EHR Key Features Necessary for Delivering Optimized AC Therapy

Part 4 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines.

To pick up where we left off on part 3, let’s review a few priority key features of an EHR that can advance chronic oral anticoagulant care as outlined by the EHR Task Force Consensus Group.

Key features depicted in Figure 1 include:

  • patient level demographic data
  • treatment data including the indications for anticoagulant therapy
  • for those on warfarin, the target INR intensity and start date
  • recommended duration
  • tablet strength of warfarin
  • risk factors for bleeding and thrombosis
  • main route and frequency of administration of anticoagulants or other drugs
  • importance of communications both from provider to patient, but also from patient back to provider
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Topics: Anticoagulation, Interoperability, Patient Engagement, Development, Warfarin, DOAC, Adverse Drug Events, Clinical Workflow, NOAC, Point of Care AC

Clinical Decision Support Tools in the Dosing of Both Warfarin and NOACs

Part 3 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines

In my view, one of the most important ways to achieve optimum warfarin control is the use of an anticoagulation, electronic clinical decision support tool that incorporates a validated warfarin dosing nomogram.  We’ve also learned in the last 20 years how we can really move the needle with respect to improving the quality of care for patients on NOACs.  Managing patients on NOACs is also a critical component of anticoagulation electronic decision support.

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Topics: Anticoagulation, Hamilton Nomogram, Validated Survey Instruments, Warfarin, Adverse Drug Events, Clinical Workflow, NOAC, TTR

Use of Outcome Measurements: Warfarin, NOACs and How They Apply to MU and National Quality Measures

Part 2 in a 5 part series - Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines

The Center for Medicare and Medicaid Services (CMS) has identified  Time in Therapeutic Range (TTR) as a Meaningful Use goal, and highlights that TTR’s greater than 70% represent high quality warfarin care, TTR’s of 65-70% are considered acceptable warfarin care and TTR’s under 65% needs improvement. 

The National Quality Foundation has endorsed multiple quality measures for anticoagulation, which include both inpatient and outpatient measures.  The outpatient measures include monthly testing of INR values, more frequent testing of INR values of individuals taking interacting medications such as antibiotics, and implementation of measures to ensure that regular and frequent INR testing is done on patients using Coumadin. 

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Topics: Anticoagulation, Meaningful Use, Warfarin, DOAC, Adverse Drug Events, NOAC, National Quality Measures, TTR

5 Part Series: Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines

Part 1: Adverse Drug Events Related to Anticoagulation/VKA 

Coumadin (warfarin) is a tough sell.  As someone who has directed some of the largest Coumadin clinics in the country over the last 20 years, it is true that Coumadin is a drug that is impossible to dose, tough to monitor, causes death when used properly, and then lifesaving, when it’s not trying to kill you. 

It shouldn’t be surprising that warfarin is the number one cause of adverse drug-related events in older Americans requiring hospitalization.  In a fairly recent study (New England Journal of Medicine, 2011; 365:2002-12), adverse drug events (ADE’s) associated with warfarin occurred more often than oral antiplatelet agents, oral hypoglycemic agents, opioid analgesics, Digoxin as well as other high-risk drugs.

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Topics: Anticoagulation, Hamilton Nomogram, Warfarin, DOAC, Adverse Drug Events

Quest for Best Care: Strategic Moves that Engage Clinical Practice Leadership

Part 4 in a 4 Part Series. Read Part 1, Part 2.

In part 3 of this series, we focused on the point of care team as a vital source of organizational learning and innovation. In part 4 of this post, we will talk about how point of care clinicians can lead from the front lines through clinician-driven networks of knowledge exchange and the right data tools to address the needs of the local population and to transform the way we work.


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Topics: Anticoagulation, Interoperability, Industry Insight, Clinical Workflow

Quest for Best Care: Leverage Points Create Big Change

Part 3 in a 4 part series (Read Introduction and part 1)

In part 2 of this series we talked about the need for data-driven clinical tools that better address the paradoxical realities of clinical practice, such as the prevention of adverse drug events (ADEs). Balancing this tension is paramount to achieving optimal patient outcomes. In part 3, we will link the health care team’s capacity to adjust to the situational demands of a rapidly changing clinical work environment to value-based care and the return on our healthcare investment.


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Topics: Industry Insight, Adverse Drug Events, Clinical Workflow

Quest for Best Care: Balancing the Tension of Clinical Paradox

Part 2 in a 4 part series.  Click to read the Introduction and Part 1.

Every patient has a unique set of needs and expectations. According to the Institute of Medicine (IOM), there are unprecedented challenges to how we identify and deliver the most appropriate care for individual needs and conditions (IOM, 2011).  In part one of this series, we looked at clinical tools that can help us to understand the most vulnerable patients and the care they require. In part two, we will peel back the problem of, “Care that is important is often not delivered. Care that is delivered is often not important (IOM, 2011).”

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Topics: Anticoagulation, Patient Engagement, Industry Insight, Adverse Drug Events

Quest for Best Care: Technology Tools That Can Change Your Practice

Part 1 in a 4 Part Series.  Read the Introduction here

In part one we will explore knowledge management tools that will elevate your practice, facilitate safe, evidence-based, data-driven decision making, and promote the point of care as a vital source of learning, innovation, and leadership.

  It has been estimated that by 2020 the average person will create an entire gigabyte of health data every day (McKinsey, 2017). As a clinician, how do you make sense of all that information? What are the implications as patients transverse across large, complex and dispersed organizations and systems of care? Clinicians want to be equipped to efficiently, effectively and safely manage the health care needs of patients while staying engaged to improve our system of care. Learning and contributing to health care advancement is in our DNA. I want to talk about how point of care clinicians can insert their DNA into their systems of care as a driver of learning and innovation. We will take a look at examples of cutting-edge ways to engage your practice and your patients.

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Topics: Anticoagulation, Industry Insight, DOAC, MACRA

Part 2: How Anticoagulation Software Enables Measurable Analysis of Patient Care Outcomes

Posted by Jay Syverson

In Part 1, we discussed the focused information clinicians need to quickly assess an anticoagulation patient’s health and a review of patient treatment plan trends.  Here in part 2, we will discuss the many ways to identify patients who are at risk for drug interactions or re-admissions, and evidence-based guidelines that support dosing decisions.

 Identify Patients at Risk

There are many ways to identify patients that require a bit of extra scrutiny.  PCDS believes it is important that a clinician is immediately made aware of any patients with higher than normal levels of risk given their care plan.  We further believe it is important that risk identifiers be objective and measurable.  That is why AC has three validated survey instruments built into the application for easy access, execution as well as to clearly demonstrate the results of completed surveys when they indicate patients may be at risk.

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Topics: Anticoagulation, Patient Engagement, Hamilton Nomogram, Validated Survey Instruments, Warfarin

AC Innovation at the Point of Care: 2018 Anticoagulation Boot Camp


What an exciting time to reflect on advances in anticoagulation management, and spotlight point of care clinicians dedicated to translating excellence into action. The stage was Austin, Texas, and featured a compact, 2-day Anticoagulation (AC) Boot Camp hosted by the AC Forum board of Directors on April 23rd and 24th.  A nationally recognized panel of AC experts presented on critical touch points in AC management and emerging research trends. The panel also engaged attendees in open and rigorous discussion during “chalk talk” sessions. Attendees and experts alike wrestled with the challenges of AC management to include transition in care, health information exchange, new AC agents, quality improvement, and special populations.

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Topics: Anticoagulation

PCDS believes that the complexity of patient care can be captured in a clear and meaningful way, enabling informed decision-making throughout the coordination and management of care.  We believe that connecting the point of care team with actionable information promotes patient engagement, analytic approaches to best practices, and system-supported collaborative efforts that are vital to patient safety, ambulatory service, and value across diverse health systems.

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