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.
We have 23 specialty anticoagulation clinics comprising nearly 5,000 patients. We are integrating the PCDS AC system both within our laboratories as well with our Allscripts EHR. The Northwell Health System is an extremely complex system with multiple role-based workflows for managing warfarin to include a Medical Assistant (MA), Registered Nurse (RN), Nurse Practitioner (NP)/Physician Assistant (PA), Pharmacist (PharmD) as well as a Physician (MD/DO).
When we had to devise an anticoagulant strategy, we had to incorporate all of these workflows in all of our satellite locations. What we did, is use a “hub and spoke” model below.
In the hub, we are using the Point of Care AC tool to deliver standardized protocols to include warfarin and direct oral anticoagulants (DOAC) dosing and INR tracking as well as periprocedural antithrombotic management. Early analysis of quality improvement metrics indicate:
o Minimum 10% increase in average population-based TTRs
o Prevent 7 anticoagulant-related serious ADEs per 100/patients/year (national average per ADE is $47,000)
o Full EHR integration with anticoagulant management capabilities that include periprocedural heparin bridging and management of DOACs
o Real-time quality metric tracking at a system, clinic, and provider level, integrated thrombotic/bleeding risk scores and clinical decision support triggered by evidence-based guidelines
o Increased workflow efficiency
o Point of Care AC is rolling out CDS system-wide via EHR to all 23 anticoagulation specialty clinics at Northwell Health and many more non-specialty clinic locations by end of 2019
Also, Point of Care AC complies with all 78 features recommended by an Anticoagulation EHR Task Force to deliver optimal AC care and meet new guidelines from the Joint Commission. Across our population of about 5,000 AC patients, this represents a very important step in advancing the quality of care in the reduction of adverse drug events (ADEs) for our oral anticoagulant patients.
Thank you for taking the time to read this 5 part series on Improving the Quality of Chronic Oral Anticoagulation with Evidence-Based Guidelines. If you have any further questions in regards to how Northwell Health System is using the Point of Care AC tool throughout our network and its integration with our EHR system, please use the comments below and I will respond at my earliest convenience.