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
This list of key features includes important AC issues such as plans and other protocols for interrupting anticoagulant therapy, missed appointments, and other pertinent laboratory values such as hemoglobins, hermatocrits, INR’s, etc.
The task force determined that in order to achieve optimal anticoagulant care an EHR needs to have these elements as well as be accessible in a way that would make sense to the end user. Additionally, as mentioned in my previous post, the new CMS payment system, referred to as MACRA/MIPS, has assigned a “high weight” rating for anticoagulant management improvement as well as participation in a systematic anticoagulation program.
As we head into the next 10 years, perhaps the most sophisticated AC tool is the Point of Care Decision Support Anticoagulation (AC) system. This system was carefully designed to meet all of individual (78) EHR features to facilitate excellence in anticoagulant care for the individual patient as well as the AC population served.
The PCDS AC app provides a system of care for capturing relevant laboratories and adverse events associated with anticoagulant care. As part of a comprehensive system of care, the AC app incorporates the only validated warfarin dosing nomogram available, the Hamilton Nomogram. In addition to managing patient encounter profiles, the AC app includes AC care during critical patient touchpoints such as the peri-procedural setting. Alerts are also designed to focus on critical issues such as high risk medication interactions dependent on the type of anticoagulant used.
The Point of Care AC system provides the tools to enable, both at the provider level and the health system level, the ability to deliver systematic, coordinated and sophisticated anticoagulant management right at their fingertips.
As someone who has been doing this for 2 decades, and as someone who has seen other anticoagulant software systems, there is no comparison to the robust, intuitive and sophisticated decision support software system of Point of Care for the delivery of comprehensive anticoagulant care.
In this chart, we see some of the real advantages of Point of Care AC:
- use of validated dosing nomogram
- auto alerts
- transition support
- peri-procedural tracking module
- detailed reporting
- use of heparin bridging and switching
- full integration with EHR’s (agnostic and bidirectional)
The Point of Care Decision Support AC Software and system are built for the future. Do you use an AC management tool in your practice? What are the features that enhance your practice and what roadblocks are you experiencing? Part 5 (and the final post) in this series will include information on Northwell Health’s integration with Point of Care AC software.