- In a recent study, MU Health Care found that EHR use can be useful in improving anticoagulation therapy between outpatient and inpatient settings and across providers.
Researchers conducted the study in response to challenges arising from transitions of care from in-hospital to post-hospital during warfarin management.
Providers have historically struggled with warfarin management, resulting in a variety of problems including dosing errors, medication nonadherence, and insufficient monitoring.
Furthermore, researchers noted a trend of adverse drug events following transitions of care caused detrimental outcomes. A lack of awareness on the part of the patient could lead to seemingly innocuous mistakes leading to more serious repercussions.
For example, the commonly-used blood thinner, when mixed with vitamin K, can have severe consequences. Vitamin K is prevalent in foods such as lettuce and broccoli. Without proper outpatient monitoring, unknowing patients could subject themselves to a dangerous chemical cocktail and put themselves at risk.
Fortunately, the MU Health Care study found EHR use could prove useful in mitigating confusion among providers and pharmacists after patients are discharged, leading to better monitoring of patient care and more accurate dosage.
"Previous research indicates that adverse effects of warfarin accounted for 33 percent of annual emergency hospitalizations for patients 65 or older in the United States," said primary care physician and leader author Margaret Day, MD, who also serves as Medical Director at MU Health Care's Family Medicine-Keene Clinic. "At MU Health Care, we designed the 'Outpatient Warfarin Management Order' record in response to The Joint Commission's call for institutions to reduce possible patient harm associated with the use of warfarin."
Prior to the study, physicians specified warfarin management plans manually on paper according to their personal practice preferences at the time of discharge. As of November 2010, EHR technology revolutionized this system by instead utilizing a computerized order entry.
The modified EHR workflow created an order prompting physicians to include five elements for warfarin management upon discharge. This study assessed the impact of this intervention as a means of communication between patients and healthcare providers.
The MU Healthcare EHR system generates a health summary for each patient including a full medical history. Researchers found the discharge summary was particularly useful in communicating the five elements for successful warfarin management.
The five elements necessary to proper warfarin management include expected duration of treatment, date anticoagulation started, and concurrent treatment, among others.
Researchers concluded that all five elements were included in the discharge documents of 42 percent of patient charts before the intervention in comparison to 78 percent of charts after the intervention.
Additionally, researchers found that individual elements were included in patient charts between 84 percent and 94 percent of the time following the implementation of EHR systems in outpatient monitoring.
"Of the 28 physicians and pharmacists who took part in the survey, 61 percent said that the new warfarin order was 'user friendly and accessible,'" Day remarked.
A record review team of authors and pharmacy students reviewed post-discharge orders and discharge summaries for each patient to indicate whether the five key elements for warfarin management were addressed in the patient’s transition from inpatient to outpatient.
While the study demonstrated the value of EHR use in improving anticoagulant therapy between outpatient and inpatient settings and across providers, the study was limited to one health care system’s experience.
In a user-satisfaction survey conducted after the study, 61 percent of providers reported that the new warfarin order form was “user-friendly and accessible,” according to the study.
Additionally, a majority of respondents stated the order form improves warfarin management through “inclusion of pertinent management data” as well as “clear expectation of warfarin management team and supervising physician discharge.”
Ultimately, the study encourages EHR use in warfarin management expands across providers and regions to reduce errors in outpatient monitoring.