HFREF

Heart Failure Decision Support

Optimizing workflow for dose optimization from guidelines & quality measures reporting

The What – Automation of Decision Support

  • Automated Dose Optimization solution in brief

    • 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
  • Quality Measures Reporting

    • Structured Data elements required
    • Unstructured Data required
    • Problem List, Manual Patient Identification
    • “Get With The Guidelines” Program for AHA
    • Healthy Planet Tools

Guidelines as Driver in Decision Support

  • 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

  • C Suite buy-in, involvement of internals teams for evaluation of solution, vendor selection, EHR engagement and front line staff.

    • Timeline

      • Detail initial internal discussion/vision
      • Consideration of additional resources vs. tech solution
        • Impacts to end users
  • Intended Gains

    • Embedded Solution, decreased disruption
    • Revenue return for Guidelines adherence
    • Decision Making Buy-In for Automation
      • C Suite Support
      • Cardiology Department
      • IS Support

The Why: Advantages of Clinical Automation

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)

 

CLICK HERE FOR: ACC/AHA/HFSA 2017 HFREF OPTIMIZATION GUIDELINE

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

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