Cardiac Patients Remain Healthy with the Help of EHRs
Cited: On the Record Magazine
A program that cut cardiac deaths by 73% by linking coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an EHR has kept patients healthy two years after they left the program by keeping them in touch with their caregivers and counselors, according to a randomized study by Kaiser Permanente (KP) published in The American Journal of Managed Care.
This is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, according to researchers. The Clinical Pharmacy Cardiac Risk Service at KP Colorado combines the KP Healthconnect EHR with proactive patient outreach, education, lifestyle adjustments and effective medication management. The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminder letters.
“Because of lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the healthcare system through our electronic health record,” says study lead author Kari L. Olson, PharmD, a clinical pharmacy specialist with KP Colorado is Cardiac Risk Reduction Program. “The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-effective manner.”
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In the study, 421 patients in the Clinical Pharmacy Cardiac Risk Service with well-controlled blood pressure and cholesterol levels were randomized so that 214 continued in the program to receive intensive direct counseling from the control team. The other 207 patients were discharged from the program back to their primary care physician. The mean age of the trial participants was 72 and 74% were male.
The patients who were discharged from the program had electronic reminders and nurture it to ensure it their lipid panels were ordered annually, with the results sent directly to their primary care physician. The discharged patients also received reminder letters, generated by KP HealthConnect, indicating they were due for a lab test. The study found that patients discharged from the program maintain control of their risk factors with the help of electronic reminder letters. The EHR intervention was as effective as keeping cholesterol and blood pressure in check compared to the more intensive counseling approach offered to those patients who stayed enrolled in the program.
The program also achieved the following results:
- Patients have an 88% reduced risk of dying of a cardiac related cause when enrolled within 90 days of a heart attack compared to those not in the program.
- The number of patients needing their cholesterol goal went from 26% to 73%.
- The number of patients screened for cholesterol went from 55% to 97%.
The coordinated, evidence-based care, enabled by KP HealthConnect and an electronic care registries increase the survival rate dramatically among patients enrolled in the service. It is estimated that more than 135 deaths and 260 costly emergency interventions were prevented annually as a result of improved care. Now, the latest study results suggest that once a program has helped get risk factors under control, patients can then be discharged and followed virtually with the same success.
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My Take: I think this research hits the nail on the head! The era of the EHR is here to stay. The faster we can get implemented and in use, the healthier people will be. It makes it possible for someone who has a chronic condition to travel because a doctor can easily check their medical records within minutes. This is even more important in an emergency situation.
The EHR is the best thing that could happen to the healthcare industry. For example, you are deathly allergic to penicillin, however the accident you were just in makes it impossible to determine this. The EHR allows the emergency room doctors to discover your allergy before prescribing penicillin for your actions, whereby saving your life.
An electronic health record also makes it easier when you move. You do not have a bunch of paperwork to carry around with you, which could easily get lost in all the stuff and move. Then you have to go through the process of contacting your old doctors and requesting a copy of their work records and possibly paying out a copy fee.
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