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January 27, 2017

How MU Health Care used EHRs to improve medication management

Daily Briefing

    The University of Missouri Health Care's (MU Health Care) reduced patient confusion and eased provider communication through a low-cost EHR system update, according to a new study released by MU Health Care researchers. 

    Margaret Day—lead author of the study and a primary care physician and medical director at MU Health Care's Family Medicine Keene clinic—explained that the use of warfarin, a common blood thinner, can be "potentially very complicated and dangerous." Adverse effects from the drug account for 33 percent of medication-related emergency hospitalizations among patients ages 65 and older.

    That's why medication adherence is so important for patients once they are discharged, Greg Slabodkin writes for Health Data Management.

    Previous system was confusing, outdated

    Before the new system was implemented, physicians at MU Health Care had outlined patients' post-discharge warfarin management plans on paper. But the paper process was outdated, made it difficult for physicians to later obtain the files, and caused confusion for providers, patients, and pharmacists because warfarin plans often change.

    "It was not uncommon for patients to fall through the cracks," Day said.

    How it works

    To improve the system, researchers modified MU Health Care's Cerner EHR system based on input from physicians, pharmacists, and IT professionals to create an outpatient warfarin management order in patients' discharge summaries.

    Under the new system, physicians are prompted at patient discharge to enter five key elements needed to manage a patient's warfarin plan, including the reason the patient is taking the drug, the duration of treatment, the date treatment started, and any other concurrent treatments. The system notifies a patient's referring provider about transition care and updates pharmacies about any changes to a patient's dosage.

    "The information entered is visible to the patients and their community health care providers," Day said. "In addition, the record also coordinates communication to pharmacy services for any dosage updates."

    EHR tweak eased communication, lessened patient confusion

    In a study assessing the new system, MU Health Care found that the percentage of patients' discharge summaries that contained all five elements of warfarin management increased from 42 to 78 percent, and the percentage that contained at least one of those five elements increased from 84 percent to 94 percent. That difference was enough to reduce patient confusion about treatment, as well as improve data sharing with patients' post-discharge providers, Marla Durben Hirsch writes for Hospitals & Health Networks.

    In addition, the study also found that 61 percent of physicians and pharmacists said the new process was "user friendly and accessible," according to Day.

    MU Health Care did not determine whether the new system improved patient outcomes, but Day said researchers may follow up on that.

    "The severe outcomes (of inadequate warfarin management), particularly among older patients is pretty striking," Day said. "So a systemwide intervention that didn't cost anything except some time and human resources might help make safety improvements and down the road cost improvements" (Durben Hirsch, Hospital & Health Networks, 1/25; Slabodkin, Health Data Management, 1/16; EHR Intelligence, 1/18; UMHC release, 1/10).

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