A new electronic health record (EHR) tool could help physicians quickly and accurately flag patients that should be referred to a nephrologist based on indicators that may signal the risk of kidney failure. Designed by Brigham and Women’s Hospital (BWH) investigators, this tool draws upon recent research that has identified several tests that can be used to calculate an individual’s risk score. Now, an automatic calculator can be built into EHRs and displayed prominently for a physician to see when they open a patient’s record. The paper detailing the design and implementation of the application appeared online in the July 2017, issue of The Journal of the American Medical Informatics Association.
“Retrospective studies of patients who have had to go on dialysis show that being referred to a nephrologist just a few months earlier can have major benefits,” says corresponding author Lipika Samal, MD, MPH, a clinician investigator in the Division of General Internal Medicine. “We want to make it as easy as possible for a physician to quickly access and track a patient’s risk. This web-based tool automatically displays a risk score within the health record, making it easier for a physician to spot disease progression and make a referral, if appropriate.”
The new clinical decision support tool calculates and displays kidney failure risk based on criteria identified from a large cohort study conducted by Canadian researchers. Predictive risk factors that go into the calculation include serum and urine tests that were collected during routine care. If test results for any of these predictive measures have not been collected and are not in a patient’s record at the time of a visit, the tool displays a recommendation to order the tests. Otherwise, the tool will display a five-year kidney disease risk score, and if the risk is high, a referral to a nephrologist is recommended.
“Primary care providers can use predicted risks of kidney failure for individual patients to make the best decisions for management and referral to nephrologists,” says Sushrut S. Waikar, MD, director of Renal Ambulatory Services for the Division of Renal Medicine.
The tool was deployed outside of the EHR in a way that would allow it to be used with different EHRs by utilizing interoperability standards called continuity of care documents (CCDs). The tool extracted the necessary tests from this interoperable document.
The research team validated the tool in 255 patients and deployed it to 10 primary care clinics. The team made improvements and updates to the tool based on feedback from physicians. During the pilot, they processed more than half a million CCDs to diagnose chronic kidney disease and to generate risk scores for those patients.
Because of the interoperable nature of the tool, the team sees an opportunity to deploy this single application across multiple EHRs. The plan is to implement it in eCare at BWH within the coming months.
“One of the positive things about EHRs is that there is now a wealth of data that can be used to help us better predict an individual’s risk for CKD and other chronic and progressive diseases, like CKD,” says Dr. Samal. “We have the opportunity to use EHRs to improve patient care – tools like this one can help us seize that opportunity.”