Title: How Evidence-Derived Clinical Decision Support within Electronic Health Records Can Improve Delivery of Optimized Anticoagulant Therapy: The Point of Care AC Decision Support Experience

 

Alex C Spyropoulos, MD, FACP, FCCP, FRCPC

Professor of Medicine – The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Professor – The Center for Health Innovations and Outcomes Research; The Feinstein Institute for Medical Research; System Director – Anticoagulation and Clinical Thrombosis Services; Northwell Health at Lenox Hill Hospital

  

Abstract

Anticoagulant (AC) therapy - including oral anticoagulants (OACs) such as warfarin or the Direct Oral Anticoagulants (DOACs) - is used by millions in North America but as a class are medications that are among the most likely to lead to serious adverse events leading to emergency department visits and hospitalizations.

Evidence-based therapy as discussed by antithrombotic guidelines and as mandated by national quality mandates promote a systematic approach to managing patients on chronic OAC using dedicated anticoagulant management systems, but implementation of this approach is often sub-optimal. Although Electronic Health Records (EHRs) have the potential to improve the quality of care of anticoagulant management, they have not incorporated many of the specialized features necessary for the optimal delivery of AC therapy, especially for patients on chronic OAC.

Recently, a consensus statement from the EHR Task Force of the New York State Anticoagulation Coalition generated 78 recommended EHR features across 20 key discrete areas for necessary implementation into EHRs in order to deliver optimal AC care. These elements, along with new guidelines from the Joint Commission, include key decision support in the management and dosing of patients on warfarin and DOACs as well as the ability to have patient tracking and record keeping.

The Point of Care AC Decision Support system has been built to incorporate all of these key features that are necessary to safely treat AC patients in the digital era of antithrombotic therapy, with the capacity for complete integration into EHRs within large health systems that include complex workflows. Key quality metric improvement of AC therapy as well as marked efficiency for the various delivery models of AC care within a large healthcare network using the Point of Care AC Decision Support will be discussed.

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References

  •  Spyropoulos AC, Viscusi A, Singhal N, Gilleylen J, Kouides P, Howard M, Rudd K, Ansell J, Triller DM. Features of electronic health records necessary for the delivery of optimized anticoagulant therapy: Consensus of the EHR Task Force of the New York State Anticoagulation Coalition. Ann Pharmacother 2015; 49(1):113-24.
  • National Patient Safety Goal for Anticoagulation Therapy. R3 Report | Requirement, Rational, Reference.  The Joint Commission, Issue 19, Dec. 7, 2018.