Effect of Automated, Point-of-Care Electronic Medical Record Screening for Appropriate Implantable Device Use in Heart Failure Patients

摘要

The authors evaluated the effects of an electronic health record (EHR)-based real-time screening of outpatients for potential defibrillator therapy on practice metrics. Based on ejection fraction (EF) ≤ 35% and absence of a defibrillator, the physicians were prompted for an action: electrophysiology consultation, EF evaluation, or "not indicated." Although the number of patients screened remained stable at nearly 6000 per month, consultations and echocardiograms peaked early but returned to a low steady state by 10 months. The number of actual device implants did not increase appreciably as a result of this program. Implementation of a real-time EHR screening algorithm in a busy clinical practice is feasible and generally unobtrusive, without an effect on productivity. Its impact on adherence to guideline-based recommendation is not notable in this case. The number of resulting actionable items declines dramatically and plateaus by 10 months, affording an opportunity to cycle, rather than add, other screening protocols.