HFREF
Heart Failure Decision Support
Optimizing workflow for dose optimization from guidelines & quality measures reporting
CarePaths For Heart Failure
The What – Automation of Decision Support
- Software that evaluates medical record content of HF patients using NLP technology to identify opportunities for guidelines-based medication selection and dose optimization
- Integrated into EHR at the point of opening orders, opening ambulatory chart, and discharge navigator
- Summarized evidence and single click drug ordering
- Structured Data elements required
- Unstructured Data required
- Problem List, Manual Patient Identification
- “Get With The Guidelines” Program for AHA
- Healthy Planet Tools
- Clinical NLP service that identifies evidence from Echo Reports and Progress Notes
- Supplies EHR with evidence in real-time to make suggestions to physicians
- Supports faster retrospective and real-time chart review and reporting
- Configurable logic across sites based on treatment guidelines
The Who – Automation of Workflow
Timeline
Detail initial internal discussion/vision
Consideration of additional resources vs. tech solution
Impacts to end users
- Embedded Solution, decreased disruption
- Revenue return for Guidelines adherence
- Decision Making Buy-In for Automation
- C Suite Support
- Cardiology Department
- IS Support
Reduce time spent on manual review of clinical documents
Reduce time spent on calculating optimal medication selection and dosing from guidelines
Increase HF registry integrity
Expand coverage beyond human ability
- Ease burden of finding and reviewing all documentation including Echo Reports
- Ensure important inpatient and ambulatory medication optimization is not missed
- Apply algorithms to identify best medications for patients
- Integrate into EHR workflow at the right points for greatest compliance
- Automate patient selection for registry by validating Ejection Fraction and Medications
- Keep track of patient data and outcomes continuously upon every visit
- Process complex algorithms looking for Rx, Dx, Lab, Vitals, Procedures and other data combinations
The How – Automation of Workflow
Guideline Algorithm Part 1: Med Selection
Guideline Algorithm Part 2: Dosing
Guideline Algorithm Part 3: Monitoring
Sample Physician advice triggered by Clinician Opening Orders workflow:
- EF Auto-Extracted from latest Echo
- Evidence of deviation of patient care based on latest Guidelines
- Specific Drug & Dosing Regimen Advice
- Link to algorithm justification from Guidelines
Patient has HFREF with an EF of 25-35% from the latest Echo reported on 7/7/19.
Patient is Stage C or D Heart Failure with Reduced Ejection Fraction & hemodynamically stable.
- Consider increasing the dosage of Beta Blocker to Optimize Therapy
- Consider replacing the ACE Inhibitor with an ARNI
- Metoprolol succinate 200 mg QD
- Sacubitril/valsartan 49/51 mg BID
- Electrolytes (Potassium) + Renal Function (eGFR, CrCl, SerumCr)
Application developed through a collaboration between Hiteks Solutions and Rush University Medical Center
Enhanced BPA for HFREF Detailed Workflow
Output: Quality Measures Reporting
Clinician Perspective
Supports physician compliance with guidelines-based orders
Available at convenient points in clinical workflows
Compliant with institutional compliance department
BPA appears as Physician opens orders and other points in workflow
Supports ease of decision-making
All evidence is easily identifiable
Echo report content for Ejection Fraction, labs, vitals and meds