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- Title
(MOC11) Improving Understanding of Clinical Phenotype for Patients with Multiple Sclerosis: Design and Implementation of Smarttools in Electronic Health Record Systems.
- Authors
Grader-Beck, Thomas; Yujie Wang; Fitzgerald, Kathryn C.; Calabresi, Peter A.; Mowry, Ellen M.
- Abstract
Background: Patients with multiple sclerosis (MS) frequently require complex clinical care and decision making, including monitoring for relapses, chronic immunosuppressive therapy, and extensive serological and imaging work-up. Modern electronic health record (EHR) systems offer the opportunity to facilitate understanding of each patient's clinical phenotype by allowing discrete data collection, as well as summarization and presentation of critical information to providers. However, such tools often require custom design and build, for which many institutions do not have assigned resources. Objectives: To implement a comprehensive set of EHR-based Smarttools for patients with MS that can be shared among institutions to improve data quality and understanding of patient phenotype. Methods: The Epic EHR system was used to develop several Smarttools. A Smartform was designed to allow discrete data collection on items considered critical by MS experts. Content included date of diagnosis, documentation of relapse characteristics, such as date, duration and therapies, current and past immunosuppressive therapy, critical imaging and results of CSF studies. Longitudinal caption of disease impact was incorporated, including number of falls and ability to walk since last visit. Logic was applied to conditionally display the SmartForm for patients with a diagnosis of MS. A synopsis was designed to visualize longitudinal data, and a SmartPhrase was implemented to automate documentation of discrete data in provider notes. Results: Version 1 of the MS Smartform was implemented in August 2017. Over the course of 18 months, data on approximately 1000 unique patients were collected. The SmartForm was found to be easily accessible and easy to navigate by providers, and the completion rate was high. Based on the initial experience, version 2 of the Smartform was designed and was recently implemented with minor modifications to minimize erroneous data collection, and a predefined list of immunomodulatory therapies and more detailed information about reasons for starting and stopping therapies was included. Data entry for the full cohort of ~3000 patients is ongoing. With the support of the Epic Neurology Steering Board, all discrete data elements were incorporated into the Epic Foundation system to facilitate implementation of the Smartform at other institutions. Conclusions: EHR systems provide opportunities to improve understanding of complex clinical phenotype. We built a comprehensive Smartform that facilitates discrete data collection and review for patients with MS. This tool is being made available in the Epic Community library and can be implemented without charge at other institutions. Besides offering a better understanding for individual patients, it is our hope that this SmartForm will contribute to better streamlining of data collection across institutions and ultimately, better outcomes for patient care and collaborative research.
- Subjects
CONFERENCES &; conventions; MULTIPLE sclerosis; PHENOTYPES; ELECTRONIC health records
- Publication
International Journal of MS Care, 2020, Vol 22, Issue S2, p54
- ISSN
1537-2073
- Publication type
Article