Point of Care Decision Support Point of Care Blog

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

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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