Doctors more likely to prescribe preventive therapy if prompted by EHR

Purely educating doctors about the importance of prescribing certain therapies may not be enough to make a meaningful impact, according to a new Penn Medicine study.

Using acid suppression therapy -- an effective method of reducing the risk of gastrointestinal bleeding in vulnerable cardiac patients -- Penn researchers tested interventions that utilized both education and an electronic "dashboard" system linked to patients' electronic health records which gave doctors up-to-date information on which patients would likely benefit from the therapy.

Researchers found that the education on acid suppression therapy alone did not have a noticeable effect on prescribing rates, but adding use of the dashboard resulted in an 18 percent increase in needed medication orders.

IMPACT

The findings come as an increasing number of health systems are investing in system-wide EHRs, despite lingering issues with interoperability.

Before the study's EMR-linked dashboard was developed and implemented, through help from Penn Medicine's Center for Health Care Innovation, prescription rates for cardiac patients who could benefit from acid suppression therapy was just shy of 73 percent, according to the health system's data of inpatients in the Cardiac Intensive Care Unit from September 2016 and January 2017.

Afterward, from January until September 2017, when the "dashboard" was implemented, rates quickly jumped to 86 percent for patients in the CICU.

Great gains were made using this type of technology-assisted nudge, which the study team notes could improve desired outcomes in other clinical areas. Software developers at the Center for Health Care Innovation are working on similar dashboards or alerts in many other clinical areas where there is an opportunity to increase adoption of evidence-based practices.

However, the researchers emphasized that this "nudge" approach is not one-size-fits-all.

Acid suppression therapy involves prescribing patients with medications to reduce the level of acid in their stomach, which helps reduce heartburn symptoms and treat ulcers. It can also decrease some patients' risk of even developing ulcers, such as cardiac patients who are on certain medications that may increase their chance of bleeding.

THE TREND

While healthcare has made great strides in recent years with the proliferation of electronic health records, the establishment of regional health information exchanges and the development of data exchange standards and interfaces, interoperability among healthcare technologies remains very limited.

The lack of interoperability results in waste, inefficiency and clinician burnout, which can contribute to patient safety risk.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com