The electronic medical record (EMR) not only enables you to easily track and monitor patient data — including diagnoses, lab results, medications, immunizations, preventive visits and screenings, and family medical histories — to improve treatment over time, but it also can prompt you to change your prescribing practices, according to a new quality improvement study.

What Did The Study Find?

In the study, which involved prescribing acid suppression therapy, an effective treatment for reducing gastrointestinal bleeding in critically ill cardiac patients, researchers at Penn Medicine, the University of Pennsylvania Health System, have tested two intervention methods—provider education about acid suppression therapy versus an electronic dashboard system linked to patients’ EMR. Penn Medicine’s Center for Health Care Innovation designed and implemented the dashboard system.

Certain medications, such as antiplatelet or anticoagulation agents, are important for treating and preventing worsening cardiovascular disease in high-risk patients, but they increase the risk of gastrointestinal bleeding. Acid suppression therapy effectively reduces the level of acid in the stomach to prevent this adverse side effect. It involves using histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) to help prevent gastrointestinal bleeding among patients taking antiplatelet agents and/or anticoagulants.

In one arm of the study, the patient’s EMR alerted doctors to patients who would likely benefit from acid suppression therapy. The electronic dashboard stratified risk based on information derived from the patient’s EMR, serving as an automated alert and provider reminder system. In the other study arm, providers received education about acid suppression therapy.

Before the study was conducted, acid suppression prescribing rates were roughly 73% in Penn Medicine’s Cardiac Intensive Care Unit from September 2016 to January 2017. However, from January 2017 to September 2017 — after researchers had implemented the study’s electronic dashboard system — prescription rates for acid suppression therapy increased by 13% to 86.

What Does This Mean For Patients and Providers?

As a result, researchers deemed this EMR-assisted “nudge” a success that could improve patient outcomes in other clinical areas. They demonstrated that, even though clinicians should collaborate to identify best practices, there’s also a need for process technology and behavioral change strategies to put best practices into play with sustainable success.

Overall, the EMR as a validated clinical alert system holds promise to enhance patient outcomes. For example, in another study, the EMR alert system was shown to alert physicians to patients at risk of potential clinical decline.

Software developers at Penn Medicine’s Center for Healthcare Innovation are working to develop similar dashboards or alerts in other clinical areas to help providers adopt evidence-based practices. But the researchers caution that the EMR “nudge” technology approach isn’t for everybody. “No one dashboard or technology will work in every area,” said Penn Medicine’s Carolyn Newberry, MD, the study’s lead researcher, in a statement. “So it is important to partner with clinicians and identify workflow and processes where it can complement care.”