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

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: 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

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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