Use of an electronic medical record dashboard to identify gaps in osteoporosis care

A Papaioannou,M Tan,A Bell,E Mccloskey,A Langer,U Mehan,L Goldin,D Ngui

doi:10.1007/s11657-021-00919-4

Abstract

SummaryUsing an electronic medical record (EMR)-based dashboard, this study explored osteoporosis care gaps in primary care. Eighty-four physicians shared their practice activities related to bone mineral density testing, 10-year fracture risk calculation and treatment for those at high risk. Significant gaps in fracture risk calculation and osteoporosis management were identified.PurposeTo identify care gaps in osteoporosis management focusing on Canadian clinical practice guidelines (CPG) related to bone mineral density (BMD) testing, 10-year fracture risk calculation and treatment for those at high risk.MethodsThe ADVANTAGE OP EMR tool consists of an interactive algorithm to facilitate assessment and management of fracture risk using CPG. The FRAX® and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools were embedded to facilitate 10-year fracture risk calculation. Physicians managed patients as clinically indicated but with EMR reminders of guideline recommendations; participants shared practice level data on management activities after 18-month use of the tool.ResultsEighty-four physicians (54%) of 154 who agreed to participate in this study shared their aggregate practice activities. Across all practices, there were 171,310 adult patients, 40 years of age and older, of whom 17,214 (10%) were at elevated risk for fracture. Sixty-two percent of patients potentially at elevated risk for fractures did not have BMD testing completed; most common reasons for this were intention to order BMD later (48%), physician belief that BMD was not required (15%) and patient refusal (20%). For patients with BMD completed, fracture risk was calculated in 29%; 19% were at high risk, of whom 37% were not treated with osteoporosis medications as recommended by CPG.ConclusionDespite access to CPG and fracture risk calculators through the ADVANTAGE OP EMR tool, significant gaps remain in fracture risk calculation and osteoporosis management. Additional strategies are needed to address this clinical inertia among family physicians.

Highlights

Osteoporosis is treatable and fractures can be prevented [1]
In a study of 1054 family physicians in Ontario, 77% identified the lack of electronic medical record (EMR) tools as a significant barrier to implementing the osteoporosis clinical practice guidelines (CPG) [20]
Among the total patient population (171,310) across all participants (N = 84), 8,158 patients were identified in Step 1 as needing to be coded with osteoporosis or fracture in the EMR problem list; 66.8% (N = 5,446) of whom had osteoporosis based on documented International Classification of Disease 9 (ICD-9) 733 or with SNOMEDCT code 64859006

Summary

Introduction

Osteoporosis is treatable and fractures can be prevented [1]. it remains largely undiagnosed and untreated [2,3,4]. Fracture risk assessment can be conducted with either the Fracture Risk Assessment tool (FRAX®) [6] or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) absolute fracture risk assessment [7]. Those deemed at high risk should be considered for both pharmacological (antiresorptive agents, boneforming agents, calcium and vitamin D supplementation) and non-pharmacological (exercise, falls prevention, smoking cessation) interventions [1]. In a study of 1054 family physicians in Ontario, 77% identified the lack of electronic medical record (EMR) tools as a significant barrier to implementing the osteoporosis CPG [20]. The absence of EMR reminders and recalls for medications requiring regularly scheduled injections has been identified as decreasing adherence and causing discontinuation [11]

Methods

Results

Discussion

Conclusion