Point of Care Decision Support Point of Care Blog

Alex Spyropoulos, MD, FACP, FCCP, FRCPC

Dr. Spyropoulos is a Professor of Medicine at the Zucker School of Medicine at Hofstra/Northwell, Professor at the Center for Health Innovations and Outcomes Research at the Feinstein Institute for Medical Research, and System Director of Anticoagulation Services and Clinical Thrombosis for the Northwell Health System in New York. He is an internationally recognized thought leader in the field of clinical thrombosis and anticoagulant therapy and has been instrumental in the development of hospital-based and outpatient-based protocols for the use of anticoagulants, clinical use of the direct oral anticoagulants, and the management of anticoagulant therapy in perioperative settings and special populations. Dr. Spyropoulos is also the Chief Clinical Advisor for Point of Care Decision Support.

Recent Posts

Northwell Health System's Integration with Point of Care Anticoagulation (AC) Software

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

Before we get to part 5 and the final post in this series on Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines, we previously covered:

Part 1: Adverse Drug Events Related to Anticoagulation/VKA  

Part 2: Use of Outcome Measurements: Warfarin, NOACs and How They Apply to MU and National Quality Measures 

Part 3: Clinical Decision Support Tools in the Dosing of Both Warfarin & NOACs 

Part 4: Overview of EHR Key Features Necessary for Delivering Optimized AC Therapy 

This information has led us to our final part in this series of Northwell Health System’s integration with the Point of Care Decision Support Anticoagulation (AC) management system.  We are in the process of incorporating this AC clinical decision support system within our very large, 23-clinic Anticoagulation and Clinical Thrombosis Services at Northwell Health System.  I am very proud to be Medical Director one of the largest, virtual anticoagulation clinics in the United States.

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Topics: Anticoagulation, Interoperability, Patient Engagement, Warfarin, Adverse Drug Events, NOAC, TTR, Point of Care AC

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

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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