Abstract WP397: Using Electronic Medical Record System to Influence Management for Patients with High Risk Transient Ischemic Attack

Abstract

Background: Experts consider health information technology key to improving efficiency and quality of health care. However, little is known on how the use of electronic medical record (EMR) system can affect a clinical outcome by changing its processes of care. We sought to determine if EMR could be utilized to increase urgent carotid evaluation and management of patients with transient ischemic attack (TIA). Methods: Changes were implemented in the standardized EMR TIA order set for Kaiser Permanente Northern California (KPNC) on July 20, 2012 adding: 1) a link to an ABCD2 score calculator, and 2) a recommendation that “acute TIA patients with an ABCD2 score ≥4 should undergo a carotid evaluation within 24 hours of symptom onset.” All patients diagnosed with TIA by Emergency Department physicians in KPNC were identified 6 months pre- and post- changes. EMR were reviewed for demographics, risk factors, imaging studies and clinical outcomes. Carotid evaluation, endarterectomy (CEA), stroke during the 90-day period after index TIA, and timing of CEA were examined. Results: Patient characteristics were similar for pre- and post-EMR order set change [Table]. Rates of carotid evaluations performed within 90 days post TIA were not significantly different between the pre- and post-order set change cohorts (76% vs. 80, p=0.28). However, there was a significant difference in the rates of CEA within 90-day post-TIA (pre=1%, post=4%, p=0.05). Median timing of CEA was shorter in the post-change cohort (30 vs. 2 days, p=0.17). Stroke risks within 90 days were similar between pre- and post- cohorts (13.6% vs. 12.2%, p=0.62). Conclusions: Our results suggest recommendations made in an EMR standardized order set could effectively influence physicians’ practice pattern in managing high-risk TIA patients. Further studies on the use of EMR to affect outcomes are needed.