Improvement in Quality of Care Metrics Through The Implementation of Electronic Health Records (EHR) in Renal Transplant Patient Management.

Abstract

Objective: Present our experience with Electronic Health Records (EHR) in Clinical Decision Support (CDS), Computerized Physician Order Entry (CPOE), and Health Information Exchange (HIE) in renal transplant care. Methods: Apply EHR for standardized post transplant care A)Implement protocols and flow sheets 1) Establish unified template note and flow sheets (TX chemistry, TX anemia, Tx CVD risk, Tx virology, TX HLA) 2) Establish clinical pathways with CDS to detect allograft dysfunction, drug levels, DSA's, viral surveillance and protocol biopsies. 3) Manage CDC high risk organs recipients with viral monitoring. 4) Manage post-transplant viral infections (CMV, BKV) to reduce treatment variability and improve outcomes. B) Communication: Implement HIE to improve communication between patients and staff, immediate availability of lab results and medication refills through E-prescribing. Lab results download into patient charts with critical alerts. Patients received results via secure health track emails. C) Patient care: Improved monitoring for compliance with lab testing, medication refills and follow up. Periodic reports for “at risk patients” allowed focused interventions. D) Established a standardized note to reduce variability, decrease error, and improved the quality of care. Results: At our center we performed 192 kidney alone transplants in 2013 and achieved 100% compliance with chemistry testing monitoring, 90% BKV screening, and 78% protocol biopsy. We have unified patient care for BKV infection and acute allograft rejection. We noticed an improvement in 1-year actual allograft survival (Figure) with 6m allograft survival of 98% (transplanted in 2013). Conclusion: Adopting a unified approach to patient care using EHR resulted in improvement in quality metrics via protocols and flow sheets, monitoring of compliance and better communications. The use of EHR has been associated with effective patient care with a trend towards better outcome.Figure: No Caption available.