5 EHR Optimizations for Enhanced Clinical Decision Support

Cardiovascular Risk Calculation

Implementing a clinical decision support tool into the EHR can boost cardiovascular risk factor awareness in oncology settings, according to a study published in JMIR Publications.

Individuals who survive breast cancer can face cardiovascular health issues, with many breast cancer survivors being more likely to die from cardiovascular disease than cancer, the study authors noted.

The research team developed the Automated Heart-Health Assessment (AH-HA) tool and the Vigor-Us mobile app for breast cancer survivors and integrated the AH-HA tool into the EHR system, while the mobile app collected cardiovascular health information.

Ninety percent of providers reported the tool provided useful information, 90 percent said it was effective, 100 percent said was easy to use, and 95 percent said it presented information in a useful format. Eighty-five percent of providers reported they would use the tool most or all of the time when providing survivorship care.

Although this study focused on cardiovascular health with breast cancer survivors, the study authors said the tool could be optimized for other survivor populations who could face similar risk of cardiovascular disease. The study authors also said future testing of this EHR tool should occur in a more diverse patient setting.

“The AH-HA point-of-care EHR-based visualization tool brings together personalized cardiovascular health and contextual cancer treatment data to address potential gaps in breast cancer survivorship care,” the researchers wrote.

“Our previous SPHERE study suggested that cardiovascular health clinical decision support tools are well-received in the primary care setting,” they continued. “Findings from the current study suggest that oncology providers and breast cancer survivors would benefit from and value the integration of cardiovascular health clinical decision support apps in survivorship care.”

Streamlined Workflows

Physicians spend on average 16 minutes and 14 seconds per encounter using EHRs, with chart review and documentation functions accounting for most of the time, according to 2020 research published in the Annals of Internal Medicine.

Ajay Dharod, MD, vice chair of informatics and analytics for the Department of Internal Medicine at Wake Forest Baptist Health, created a clinical decision support application alongside former colleague Mark Frankel, MD to cut back on clinician burden.

The application automatically pulls together pertinent clinical information for providers for clinical decision support, eliminating the need to manually click through the EHR.

This system is discreet, Dharod noted, with messages appearing on the side of a physician’s screen rather than stopping physicians in their tracks.

“There are simply suggestions that float in to get you thinking about costs and options, and then float away to let the clinicians do what they do best, which is care for patients, with that nudge of decision support,” Dharod explained in a July interview with EHRIntelligence.

Dharod said that time spent using the EHR has gone down and clinician EHR satisfaction has gone up at Wake Forest directly due to the implementation of the software. He added that there has not been an increase in reported adverse events, as well.

Ultimately, the EHR integration has helped clinical providers save thousands of clicks per day, by eliminating tasks that were preventing physicians from working at the top of their license.

“This has been an incredibly valuable tool for clinical providers at Wake Forest,” Dharod explained. “Several of our residents, fellows, and faculty members say they get to spend an extra 20 to 30 minutes per day focusing on patient care as opposed to digging through the EHR.”

SDOH Risk Assessment

As the healthcare industry continues to acknowledge the power of the social determinants of health, medical professionals find themselves looking for solutions for screening and documenting SDOH data. And to meet that moment, some EHR vendors are adding optimizations that streamline that process directly into the digital record.

Cerner recently announced an EHR integration, Cerner Determinants of Health, that leverages health IT to identify social determinants of health that contribute to health disparities.

Identifying social determinants of health (SDOH) such as housing instability, food insecurity, transportation barriers, and unemployment can help fill gaps in patients’ health and social care.

The Cerner Determinants of Health dashboard and supporting set of tools aim to help clinicians pinpoint these social services gaps. The health IT solution also suggests goals and resources within the patient’s care plan to target opportunities for intervention.

“Remarkably, studies show that non-clinical factors can impact as much as 80 percent of a person's overall health,” Kevin Seabaugh, vice president & Health Network general manager at Cerner, said in a public statement at the time of the announcement.

“Since our announcement at Cerner Health Conference last year, we’ve worked to help clinicians, care managers and leaders understand and address social risk factors across patients and communities,” he continued. “We are energized to hear from clients who are embracing our innovative solutions to help remediate this 80/20 imbalance and further advance health equity efforts.”

The EHR integration can also identify community-level vulnerabilities that may inform a patient’s social and care needs. The health IT’s dashboard combines geospatial data, patient clinician insights, and public data to provide a view of the conditions in which people live. This is set to give care organizations the data they need to provide targeted community outreach programming.

Cerner client Northern Light Health is using the crucial insights to provide help better care at the intersection of a patient’s health and social care needs.

“Addressing health equity and access to care issues is a critical need for us,” April Giard, DNP, MSN, NP-BC, NEA-BC, vice president and chief information officer of Northern Light Health, said in the Cerner press release. “We can’t truly provide patient-centered, comprehensive care without understanding social risk factors our patients are experiencing.”

Advance Directives

Advance directive EHR integrations can inform point-of-care clinical decision support to uphold patient’s end of life wishes.

During the height of COVID-19’s second wave in December 2020, Vanderbilt Health integrated an End of Life Care Plan into its EHR patient portal.

“Every patient’s decision regarding end of life is very personal, and the clinical care plan needs to be tailored, keeping the patient’s goals front and center,” Shubhada Jagasia, MD, chief of staff at Vanderbilt University Adult Hospital and Clinics, said in a press release at the time of the announcement.

“These decisions need to be made at the right time during the care of the patient and documented in the electronic medical record,” Jagasia continued. “This need has been accentuated during the COVID pandemic, as limited hospital visitation policies and lack of consistent family presence at the patient’s bedside makes reliable knowledge of the patient’s end-of-life wishes even more important.”

When a clinician opens a patient’s EHR, the integration alerts them to ask the patient if they have completed an End of Life Care Plan. If the patient has not completed it, the clinician can explain how to upload the information.

“Now more than ever, it’s important for us to ask these questions, and for patients and families to talk among themselves now about their wishes related to health care interventions and end-of-life care,” Mohana Karlekar, MD, director of VUMC Palliative Care, said at the time of the announcement. “Families need to know what their loved one wants so they can advocate for them appropriately.”

Precision Medicine

Precision medicine aims to improve healthcare by customizing patient care to specific patient needs.

Advancing precision medicine requires establishing an evidence base through extensive research built on genomic data at a unique scale. As precision medicine data becomes increasingly complex and available, health IT and EHRs must evolve to integrate, interpret, and deliver this data.

Epic Systems partnered with health IT vendor Foundation Medicine on a clinical decision support EHR integration for precision medicine that is expected to be available in 2022.

The EHR integration aims to support oncology practices, academic medical centers, and other health systems with easy access to precision medicine pathways while reducing manual data entry to accelerate the delivery of actionable data insights, Epic Systems said.

Once the integration is completed, providers who use the most updated version of Epic will be able to electronically order Foundation Medicine tests, such as comprehensive genomic profiling (CGP), within the EHR system. Clinical teams will also receive and view test results directly within their existing workflow.

“In order to bring the reality of precision medicine to more cancer patients, we need to simplify the process for getting oncologists access to the genomic insights they need for targeted treatment planning,” Kathleen Kaa, interim chief commercial officer at Foundation Medicine, said in a public statement at the time of the announcement.

“This integration with Epic is one of our key efforts to improve the process for ordering our tests so care teams can focus on providing the best treatment for their patients,” Kaa continued.

Foundation Medicine is also partnering with several institutions using EHR systems other than Epic’s to expand its footprint to other practices looking to enhance clinical decision support.

With EHR optimization, healthcare stakeholders can leverage valuable information for clinical decision support while maintaining their native EHR workflows.