Emergency stroke patients benefit from EHRs with decision support

Integrating electronic health records with clinical decision support and computerized physician order entry (CPOE) enabled almost double the number of emergency department patients with acute ischemic stroke to receive timely clot dissolving treatment, according to a new study in the Annals of Emergency Medicine.

The researchers, with the Kaiser Permanente Division of Research, studied 16 Kaiser Permanente Northern California Medical Centers from 2007-2012. The facilities introduced CPOE with a special electronic template, or "order set," embedded in it to help physicians make clinical decisions about stroke, including the use of intravenous tissue plasminogen activator (IV tPA) to dissolve clots for eligible patients.

Of 10,081 patients studied, 66.3 percent were treated in centers where the CPOE had been implemented. The IV tPA was administered in 8.9 percent of these patients, compared to 3.3 percent in centers without the technology. When the stroke order set was used in conjunction with the CPOE, the administration of IV tPA increased to 12.7 percent.

"We believe that our findings represent a dawning era of the electronic health record, one that blends convenience and best practices," the researchers said. "Decision support can be integrated into the electronic health record in a way that supports best practices but does not overload and distract the provider with excess clicks or busy space. Not all emergency conditions will be amenable to the development of such interventions, but for specific, time-sensitive conditions, perhaps this study might help further justify a move toward developing informed and nonintrusive physician order entry systems that are guided by best practice guidelines.

"This study provides tangible evidence that the true promise of the computerized physician order entry electronic health record is beginning to be realized," the researchers concluded.

A growing number of studies have found that EHRs and CDS can improve patient outcomes in emergency departments and elsewhere. Clinical decision support can also be better designed or customized to be more useful.

To learn more:
- here's the study's abstract
- read the announcement