Electronic Health Record Tools to Facilitate Diagnosis of Cognitive Impairment in Primary Care

Abstract

AbstractWith novel biomarkers and treatments for dementia on the horizon, the need to detect cognitive impairment at early stages is urgent. The role of primary care providers (PCPs) in the diagnosis of mild cognitive impairment and dementia is essential in meeting this need. Cognition in Primary Care (CPC) is a quality improvement program developed at the University of Washington (UW), Seattle, which includes a three‐part Continuing Medical Education (CME), clinical workflow, and electronic health record toolset to support PCPs in early diagnosis of mild cognitive impairment and dementia. This program was developed using input from UW providers in primary care practice and elements from the KAER (Kickstart, Assess, Evaluate, Refer) Toolkit developed by the Gerontological Society of America (GSA). Our pragmatic approach involved the development of tools integrated into Epic, the electronic health record system in place at UW, that can be used during a patient visit to guide PCPs through the process of evaluating cognitive function. The toolset includes 1) a list of signs that may trigger the need for a dedicated follow‐up visit to evaluate cognition; 2) a cognitive checklist for related conditions affecting cognition (e.g., potentially harmful medications, depressive symptoms, alcohol use, and obstructive sleep apnea); 3) a structured framework for cognitive evaluation including validated instruments (e.g., MoCA and AD8); 4) referrals to specialty care; 5) billing guidelines; and 6) community resources and materials that patients and care partners can use both pre‐ and post‐diagnosis. We have pilot‐tested these tools in UW primary care clinics and found high utilization both within and outside of targeted clinics indicating a halo effect of usage beyond those who attended the CME training. In this presentation, we will provide detailed descriptions of these Epic tools focusing on clinical application to total patient care. We plan to publish these workflow tools onto the Epic Digital Library to be downloaded and used by other health systems. Future plans include producing on‐demand CME training modules, a post‐diagnosis checklist, and applications for use of these tools in systems outside of Epic.