HHS is seeking to open up patient data. MedStar Health says it's got tools to make those data useful

MedStar Health launched a new tool that automatically calculates a patient's risk of having a heart attack or stroke within 10 years.

The tool enables doctors to more easily show patients their personal risk for heart disease, stroke and other cardiovascular diseases over time using easy-to-read graphics. 

"Seeing their risk on a visual display is more powerful than me telling them their risk,” said Ankit Shah, M.D., director, sports and performance cardiology for the MedStar Heart & Vascular Institute at Union Memorial Hospital in Baltimore.

The tool is embedded in MedStar's Cerner electronic health record (EHR), making it easier for physicians to use it during patient visits, health system officials said.

"People are developing great algorithms and risk calculators as standalone tools, but we heard from our clinical experts that leaving the EHR and toggling back and forth between the tool and the patient chart is not ideal to make optimal clinical decisions. It's what we call hunting and gathering in the EHR," said Kristen Miller, DrPH, scientific director at the MedStar Health National Center for Human Factors in Healthcare. 

It's an example of how health professionals will help patients make sense of the massive amount of health information that exists about them as federal health policymakers seek to open up patient data with soon-to-be-released data-sharing regulations.

(MedStar Health)

Final rules from the Department of Health and Human Services (HHS), which will drop soon, will make it easier for patients to share their health data with third-party apps.

Recent studies (PDF) show that death rates from cardiovascular disease are rising among people age 45 to 64 in the U.S after many years on the decline.

If a doctor hands a patient a pamphlet about the average risk factors of smoking or high cholesterol on heart health, that might not resonate with patients on an individual level, Miller said.

"If you show someone their own data, that's incredibly meaningful," she said, noting that doctors can turn the computer screen to show patients graphics that visualize their heart risk information.

"The tool indicates high risk, moderate risk, and low risk and patients found that incredibly valuable to see where they sit on that risk continuum," she said.

And it's also actionable information, Miller noted, as doctors can talk to patients about lifestyle changes they can make like losing weight, quitting smoking or reducing cholesterol, and show patients how that impacts their health risk using the graphics.

"Patients can see that today my risk of having a heart attack or stroke in the next 10 years is 25%, but if I make these changes, I can potentially get it down to 15% or 14%. That changes the conversation between the patient and provider," she said.

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Researchers at the MedStar Health National Center for Human Factors in Healthcare worked with Centra Health, healthcare analytics company CareJourney, software development company Asymmetrik and Cerner to develop an EHR app based on the standalone Million Hearts risk calculator for heart attack and stroke. The app includes a risk estimator, which is a clinician-facing tool, and a risk educator patient-facing tool.

Close to 600 providers, including cardiology, primary care, family medicine, and endocrinology providers, across the entire MedStar Health system that includes 10 hospitals as well as community practices and ambulatory and urgent care centers, have access to the embedded risk calculator tool during patient visits.

The project is funded by the Office of the National Coordinator for Health Information Technology (ONC) as part of the Leading Edge Acceleration Projects in Health IT cooperative agreement. In November 2018, ONC named the MedStar Health National Center for Human Factors and Boston Children's Hospital winners of nearly $2 million in combined grant funding to work on health IT projects.

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MedStar Health officials say it's the first patient-facing, interactive heart risk calculator integrated into the EHR. The tool can improve heart risk checks by supporting quicker clinical decision-making while also helping reduce technology burnout for providers with an integrated display and automatically populated patient data.

The risk calculator draws in data like a patient's blood pressure, cholesterol, history of diabetes and other factors and computes their 10-year cardiovascular event risk.

The project highlights how MedStar Health National Center for Human Factors focuses on human factor design to improve technology for patients as well as providers. The organization also is developing mobile apps to more easily put health information in front of patients.

"We're looking at what does it mean for patients to see their data and help them interpret it," Miller said.

"With the proposed [HHS] rules and this push to increase patient access to data, there is an underlying issue of 'How do you make it meaningful?' The work that we’re doing focuses on how do we show them their own data so they can understand it right now," she said.

MedStar Health researchers built the heart risk calculator tool as a SMART on FHIR app so that it can eventually be scaled nationally and used by other healthcare providers.