Abstracts

Systematically Improving Epilepsy Self-management Access Through Electronic Medical Record Integration

Abstract number : 3.397
Submission category : 13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year : 2022
Submission ID : 2205091
Source : www.aesnet.org
Presentation date : 12/5/2022 12:00:00 PM
Published date : Nov 22, 2022, 05:28 AM

Authors :
Dennis Obat, BA – Geisel School of Medicine at Dartmouth; Elaine Kiriakopoulos, MD, MSc – Assistant Professor, Neurology, Geisel School of Medicine at Dartmouth, Darmouth Hitchcock Medical Center; Trina Dawson, BA, CHW – Dartmouth Hitchcock Medical Center; Krzysztof Bujarski, MD – Dartmouth-Hitchcock Medical Center; Nicole Odom, MD – Dartmouth-Hitchcock Medical Center; Vijay Thadani, MD – Dartmouth-Hitchcock Medical Center; Melissa Crowder, MD – Dartmouth-Hitchcock Medical Center; Jane Vasquez, APRN – Dartmouth-Hitchcock Medical Center; George Culler, MD – Dartmouth-Hitchcock Medical Center; Myra Kebalka, APRN – Darmouth Hitchcock Medical Center; Lindsay Schommer, APRN – Dartmouth-Hitchcock Medical Center; Erik Kobylarz, MD, PhD – Dartmouth-Hitchcock Medical Center; Justin Mowchun, MD – Dartmouth-Hitchcock Medical Center; George Thomas, MD – Dartmouth-Hitchcock Medical Center; Kevin Williams, MD – Darmouth Hitchcock Medical Center; Channing George, BS – Dartmouth-Hitchcock Medical Center; Barbara Jobst, MD, Dr.Med, FAAN, FAES – Professor and Chair, Neurology, Dartmouth-Hitchcock Medical Center

Rationale: Evidence-based epilepsy self-management (ESM) programs are poised to broadly impact the real-world management and monitoring of epilepsy, and drive improvement of health outcomes and quality of life. Evidence for the benefits of ESM programs has grown over the past decade with over fifteen randomized controlled trials supporting the benefits of self-management interventions. ESM programs have been challenging to bring to neurology clinics and epilepsy centers, and in current clinic workflow streams they are severely underutilized. We aim to increase epilepsy center referral and patient access to the telehealth delivered ESM program HOBSCOTCH as a means to transform care and improve patient outcomes.

Methods: The Dartmouth Health Epilepsy Center is composed of multidisciplinary epilepsy specialist providers (MDs, APRNs, LICSWs, fellows). A protocol was developed, with stakeholder input, to facilitate the process of electronically referring patients to the HOBSCOTCH ESM program by establishing a “one-click connect referral" for providers within the electronic medical record system (EMR). We engaged the department embedded IT support specialist to assist with creating an EMR prompt for clinical providers to be built into the EMR system as a part of a menu of individual patient clinic checkout orders which are automatically routed to front desk administrative clinic staff. With this design clinicians were able to access one-click connect referral to the HOBSCOTCH ESM program. Provider and front desk staff education regarding the new referral pathway was provided by the primary HOBSCOTCH team. To measure the effectiveness of EMR integration in facilitating ESM referral we examined referral data for the period 9 months prior to the EMR integration of HOBSCOTCH one-click connect referral, and compared to the period 9 months post EMR integration.  

Results: In the 9-month period prior to EMR integrated referral, a total of 4 patients were referred by their providers to participate in the HOBSCOTCH ESM program. In the 9-month period post EMR integration of ESM referral for clinic providers there have been a total of 46 referrals from 14 clinical providers, which represents a 12-fold increase in referral to the HOBSCOTCH ESM program and a greater than 4-fold increase in the number of epilepsy clinicians engaging in HOBSCOTCH ESM referral. In evaluating the implementation of the new protocol, findings indicate that there were no disruptions of clinic workflow, no EMR limitations, and no administrative staff training complications.

Conclusions: These findings elucidate the need to consider ease and accessibility for ESM referral within the workflow of clinical care at epilepsy centers. Capitalizing on EMR system availability, established clinician practices and routine administrative staff workflow can help to ensure a streamlined efficient method for ESM referral and ultimately aid in improving patient access to ESM programs. Future research should examine if ESM referrals through the EMR are directly associated with improvement in patient outcomes including seizure frequency and medication adherence.

Funding: Harvard Pilgrim Health Care - 15603, CDC - U48DP006377-SIP-19-02
Health Services (Delivery of Care, Access to Care, Health Care Models)