NWT RESEARCH DATABASE

Regions: North Slave Region

Tags: health care evaluation, health services, chronic disease, electronic health record

Objective(s): To determine whether an electronic medical record based clinical alert system, which uses digital inference rules to notify providers of undocumented problems, improves problem list documentation in the Northwest Territories.

Project Description: To determine whether an Electronic Medical Record (EMR) based clinical alert system, which uses digital inference rules to notify providers of undocumented problems, improves problem list documentation in the Northwest Territories. The EMR study will attempt to replicate the findings from a study by Wright, et al. (2012). The objective of this study was “to determine whether a clinical alerting system, which uses inference rules to notify providers of undocumented problems, improves problem list documentation.” For example, if a patient has documented symptoms (in the problem list) that indicate the presence of disease, the system could be programmed to alert the patient’s physician of this, whereupon the physician could assess whether a diagnosis should be added to the patient’s problem list. The methodology of the study was described as follows: Inference rules for 17 conditions were constructed and an electronic health record-based intervention was evaluated to improve problem documentation. A cluster randomized trial was conducted of 11 participating clinics affiliated with a large academic medical Centre, totaling 28 primary care clinical areas, with 14 receiving the intervention and 14 as controls. The intervention was a clinical alert directed to the provider that suggested adding a problem to the electronic problem list based on inference rules. The primary outcome measure was acceptance of the alert. The number of study problems added in each arm as a pre-specified secondary outcome was also assessed. Data were collected during 6-month pre-intervention (11/2009e5/2010) and intervention (5/2010e11/2010) periods. (Wright, et al., 2012). The study found that introducing the alerting system resulted in improved (more accurate) patient problem lists. Seventeen targeted conditions validated in the study done by Wright et al. will be evaluated for their clinical relevance to the Northwest Territories health environment by a panel of physicians with knowledge about the northern health environment. Consideration will be given by the panel to deleting or adding targeted conditions in order to assure relevance to the study location context. The seventeen conditions include: Attention deficit hyperactivity disorder (ADHD), Asthma/chronic obstructive pulmonary disorder (COPD), Breast cancer, Coronary artery disease (CAD), Congestive heart failure (CHF), Diabetes, Glaucoma, Hemophilia, Hypertension, Hyperthyroidism, Hypothyroidism, Myasthenia gravis, Osteoporosis/osteopenia, Renal insufficiency/renal failure, Rheumatoid arthritis, Sickle cell disease, and Stroke. The final inference rules will be constructed in the territorial EMR. A cluster randomized trial will be conducted in the territorial EMR database which includes 22,000 patient charts (55% of the territorial population). Patients will be randomly assigned to intervention and control groups. The intervention will be a clinical alert directed to the provider that suggested adding a problem to the electronic problem list based on inference rules. Patients in the control group will have no such alerts. The primary outcome measure is the number of study problems added in each arm. Data will be collected over six month pre-intervention and intervention periods. The total timeline of the project is two (2) years. This is a project involving databases and no direct contact with individuals in communities, who will not be participants in the study. However, if the study provides positive findings - that is, if the EMR can be used to create an accurate chronic disease registry - residents of Northwest Territories will benefit from improved detection and monitoring of chronic conditions, with the end goal of improving health outcomes and quality of life for those living with, or at risk of developing, a chronic disease. Results will be presented to Government of Northwest Territories Health, regional health authorities, and professional associations of health care practitioners in the territory. The fieldwork for this study will be conducted from April 5, 2014 to December 31, 2014.