Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates.

Joann M Sperl-Hillen,D Brad Rindal,Karen L Margolis,Elyse O Kharbanda,Daniel M Saman,Patrick J O’Connor,Thomas E Elliott,Rebecca C Rossom,Rachel Gold,Stephen C Waring,Erik D Geissal,Jay R Desai

doi:10.5334/egems.284

Joann M Sperl-Hillen, D Brad Rindal + Show 10 more

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https://doi.org/10.5334/egems.284

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Abstract

Introduction:Priorities Wizard is an electronic health record-linked, web-based clinical decision support (CDS) system designed and implemented at multiple Health Care Systems Research Network (HCSRN) sites to support high quality outpatient chronic disease and preventive care. The CDS system (a) identifies patients who could substantially benefit from evidence-based actions; (b) presents prioritized evidence-based treatment options to both patient and clinician at the point of care; and (c) facilitates efficient ordering of recommended medications, referrals or procedures.Methods:The CDS system extracts relevant data from electronic health records (EHRs), processes the data using Web-based clinical decision support algorithms, and displays the CDS output seamlessly on the EHR screen for use by the clinician and patient. Through a series of National Institutes of Health-funded projects led by HealthPartners Institute and the HealthPartners Center for Chronic Care Innovation and HCSRN partners, Priorities Wizard has been evaluated in cluster-randomized trials and expanded to include over 20 clinical domains.Results:Cluster-randomized trials show that this CDS system significantly improved glucose and blood pressure control in diabetes patients, reduced 10-year cardiovascular (CV) risk in high-CV risk adults without diabetes, improved management of smoking in dental patients, and improved high blood pressure identification and management in adolescents. CDS output was used at 71–77 percent of targeted visits, 85–98 percent of clinicians were satisfied with the CDS system, and 94 percent reported they would recommend it to colleagues.Conclusions:Recently developed EHR-linked, Web-based CDS systems have significantly improved chronic disease care outcomes and have high use rates and primary care clinician satisfaction.

Highlights

Priorities Wizard is an electronic health record-linked, web-based clinical decision support (CDS) system designed and implemented at multiple Health Care Systems Research Network (HCSRN) sites to support high quality outpatient chronic disease and preventive care
After analyzing failed outpatient CDS systems, our multisite (Table 1) and multidisciplinary research teams initiated a series of NIH-funded research projects (Table 2) beginning in 2006 to develop an effective clinician-designed EHRlinked Web-based CDS system that would be scalable to many care delivery systems
Clinical Outcomes Published NIH-funded randomized trials show that this CDS system significantly improved glucose and blood pressure control in diabetes patients, reduced 10-year CV risk in high-CV risk adults without diabetes (Figure 3), improved smoking management in dental patients, and improved high blood pressure identification and management in adolescents [7,8,9,10,11]

Summary

Introduction

Priorities Wizard is an electronic health record-linked, web-based clinical decision support (CDS) system designed and implemented at multiple Health Care Systems Research Network (HCSRN) sites to support high quality outpatient chronic disease and preventive care. Methods: The CDS system extracts relevant data from electronic health records (EHRs), processes the data using Web-based clinical decision support algorithms, and displays the CDS output seamlessly on the EHR screen for use by the clinician and patient. Conclusions: Recently developed EHR-linked, Web-based CDS systems have significantly improved chronic disease care outcomes and have high use rates and primary care clinician satisfaction. There is much less evidence that EHR-linked clinical decision support (CDS) can improve important intermediate outcomes of chronic disease care, such as blood pressure (BP) control or glucose control in those with diabetes [2, 3]. In a time-motion study, it took primary care clinicians four minutes and 52 mouse clicks to get 80 percent of the data needed to quantify a patient’s cardiovascular (CV) risk status and identify treatment options for uncontrolled CV risk factors [6]

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Conclusion