Heart failure (HF) is a leading cause for medical care in VA. Approximately 240,000 Veterans receive care for HF in the VA. The disorder causes frequent hospitalizations and has been requiring an increasing number of outpatient visits, with about 900,000 in Fiscal Year 2009. Patients with HF require attentive outpatient care to minimize the number of exacerbations requiring inpatient care. Therapies that improve HF, such as angiotensin converting enzyme (ACE) inhibitors, beta-blockers, aldosterone antagonists, and implantable cardioverter-defibrillators (ICDs), are available but are often underused. Vulnerable populations and patients with comorbidities are especially likely to be undertreated.
Clinical Decision Support (CDS) to assist health professionals in providing evidence-based care is most successful when incorporated into clinical workflow, which for outpatient care in VA requires good integration with the electronic health record interface CPRS. However, computing recommendations for complex patients while accounting for multiple clinical characteristics of the patients requires forms of CDS beyond the capabilities built into CPRS. Work currently underway through the VHA Strategic Innovations program is developing infrastructure to link CDS systems with CPRS, to generate easily actionable items within the clinical workflow in CPRS, in a project known as the Point-of-Care (POC) CDS. ATHENA-HF is a CDS system based on HF guidelines endorsed by VA HF experts and built as part of the ATHENA-CDS system. We propose to link ATHENA-HF with CPRS using tools developed in the POC CDS project.
The long-term goal across our HF projects is to improve health care and outcomes for Veterans with HF. The short-term objective of this one-year project is to advance care of patients with HF by developing improved CDS within clinical workflow in VA. We propose to develop methods to link the CDS ATHENA-HF to the new tools in CPRS that dynamically generate reminder dialogues with active buttons. Our Specific Aims are as follows:
(1) To establish health information technology to interoperate ATHENA-HF CDS with the new tools developed in CPRS for the POC CDS project;
(2) To evaluate the accuracy of the recommendations generated by the new system, using sample VA patient data; and
(3) To evaluate and improve the integrated system by stakeholder demonstrations/interviews in a test environment, incorporating feedback from stakeholders.
This project is significant in several ways. It holds potential for improving HF management by developing a tool to facilitate translation of HF guidelines from written documents to actionable items for specific patients offered to health professionals for consideration and professional judgment. The project also holds promise of more general contributions by serving as a case example of CDS for complex clinical care linked to CPRS, providing a platform that can be extended to CDS in other clinical domains.