EHR integration into outpatient assessment workflow improved disease management in a study conducted by researchers from the University of Texas Medical Branch (UTMB) at Galveston.
In the study, recently published in the journal Respiratory Medicine, the research team hypothesized that a structured approach using information contained in the EHR system would improve compliance with clinical practice guidelines for the evaluation and management of patients with stable chronic obstructive pulmonary disease (COPD). They found that implementation of a standardized COPD “flowsheet” developed from clinical practice guidelines improved advanced assessment of COPD patients and other quality-of-life measures.
COPD requires lifetime management of the disease and places a heavy burden on the healthcare system, the researchers noted in their report. Unmanaged patients often end up in emergency departments or with hospitalizations, they wrote. The cost of treating the disease was estimated at $50 billion in 2010.
“Because COPD leads to an overall decline in lung function and quality of life, it is important to optimize the outpatient management of these patients,” said lead author Jordan Terasaki, UTMB fellow in the Department of Internal Medicine’s Division of Pulmonary Critical Care & Sleep Medicine. “Timely access to care or an action plan can avoid emergency room visits and/or hospitalizations in these patients.”
The research team developed and used an evidence-driven COPD flowsheet based on guidelines embedded in patients’ electronic records. The flowsheet appeared on-screen to prompt the provider during COPD outpatient visits. Researchers evaluated COPD patients’ medical records to compare their status before and after the flowsheet had been added to the process. In total, 200 patients were screened in the pre-intervention period and 347 in the post-intervention period.
“This intervention was primarily tested in pulmonary clinics with a goal to spread to all primary care practices at a later time within the health care system as the majority of patients with COPD are seen in those practices,” explained author Gurinder Pal Singh, a UTMB internal medicine fellow.
In the post-intervention group, researchers found a significant increase in the use of tools to measure the severity of a patient’s COPD since the last clinic visit, referrals to a pulmonary rehabilitation program, inhaler technique education, use of both short-acting rescue inhalers and long-acting lung medications and influenza vaccinations.
Specifically, comparing pre- and post-intervention periods, researchers recorded increases in the use of severity assessment by BODE index, which incorporates body-mass index, airflow obstruction, dyspnea and exercise, from 13 to 32 percent; inhaler technique teaching, from 34 to 65 percent; osteoporosis screening, from 21 to 45 percent; and influenza vaccination, from 74 to 84 percent.
“There are several reasons for low compliance with clinical practice guidelines in management of stable COPD, ranging from lack of awareness, complexity of recommendations because of coexisting medical conditions and trust in the guideline development,” Terasaki noted. Implementation of the flowsheets dramatically compliance in this study.
Singh commented that future studies should examine the impact of standardized assessment and management on outcomes in COPD patients.
Separate research conducted at the University of Missouri found that clinical notes assembled by EHR systems should be engineered so that they match the workflow and information needs of physicians.
