Prompting doctors to screen patients problems

A recent Health Department analysis found that doctors who use electronic medical alerts do a better job of keeping their patients healthy.
Researchers examined health care interactions in 51 local primary care practices, including over 6,000 patients before and after care providers started receiving prevention-oriented information and alerts through an electronic health record system developed by the city’s Primary Care Information Project.
The analysis focused on seven clinical practices that can reduce preventable deaths, including talking to patients about their aspirin intake, blood pressure, cholesterol levels and blood sugar, as well as their smoking habits and their interest in starting a smoking cessation program.
Care providers were encouraged to heed electronic reminders for their practices, which were displayed on the health care provider’s computer screen during a patient’s appointment. Electronic alerts reminded providers to ask questions, conduct screenings and offer treatments that accord with each patient’s medical history and previous care.
Care providers were more likely to screen their patients for health problems such as diabetes, obesity, and high blood pressure after they received training and used the electronic alerts.
At the start of the study, only 44 percent of care providers tested their patients’ blood sugar. After six months, 63 percent of doctors performed the test. Fourteen percent of patients controlled their blood sugar at the start, compared to 20 percent after six months.
64 percent of care providers recorded their patients’ Height/Weight Ratio, or Body Mass Index, at the start of the study. After six months, 75 percent of care providers were recording the data.
Patients were also more likely to control their cholesterol and blood pressure with the electronic alerts. Only 39 percent of patients were effectively managing their cholesterol at the outset of the program. After six months 52 percent were effectively managing it.
Of patients with high blood pressure, 49 percent had it under control at the beginning of the analysis. After six months, 56 percent were keeping the condition under control. High blood pressure is the leading risk factor for heart disease, which is the leading cause of premature death, both locally and nationally.
If blood pressure control improved by a similar margin on the national level, about 12,000 lives could be saved every year.
Only one in five care providers screened patients for breast cancer before using the electronic alerts. After six months one in three care providers performed the screening.
“This analysis of the Primary Care Information Project confirms that easy-to-implement provider prompts within a patient’s electronic health record can help transform health care,” said New York City Health Commissioner Dr. Thomas Farley. “By reminding care providers to ask patients about the most pressing health issues and to screen patients for manageable health conditions, we can ensure that more patients receive preventive care and avoid serious illnesses.”