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What Functionalities and Tools Are Available to Support HIV/AIDS Care?

You can find many EHR software packages that will allow your clinic to computerize its records.  However, the functionalities and tools included in these packages differ.  When determining which functionalities and tools would best support patient care in your practice setting, you should consider the following:

  • The effects on clinical workflow (how will an EHR influence your clinic operations?)
  • The needs and desires of your patient population (are you meeting the needs of your patients by providing access to their medical records?)
  • The linkages of your practice with other health care providers and organizations (which other specialists and hospitals do your patients receive care from?)

Certain EHR functionalities can be particularly important to support HIV/AIDS providers’ clinical workflow and to effectively collect, analyze, and report data.

Clinical Decision Support (CDS)/Drug Decision Support – CDS/Drug Decision Support is designed to provide you with clinical knowledge and patient-specific information to support your decision making.  It can offer interventions such as computerized alerts and reminders, forms and templates for entering and documenting patient information, and clinical workflow tools.  It can also help you determine a course of treatment that complies with evidence-based guidelines.  For example, if your patient is diagnosed with active tuberculosis and is not receiving antiviral therapy, a notice would post on your computer screen to remind you to begin tuberculosis treatment.  Also, if the CD4 cell count is < 200, the CDS would suggest that the patient be put on PCP prophylaxis.

In addition, functions can be built into the EHR system to assist providers in complying with recommended drug regimens and to ensure that the appropriate drugs are prescribed.  For example, for a patient with a lipid problem of isolated high LDL, your system would recommend a statin as the preferred drug, and suggest Pravastatin 20 mg/day (max. 40 mg/day), Fluvastatin 20-40 mg/day, or Atorvastatin 10 mg/day.  It would caution providers as to contraindicated drug combinations; Lovastatin and Simvastatin, for example, should not be prescribed for patients on Protease inhibitors (PIs).

The EHR Incentive Program (‘Meaningful Use’) requires that eligible professionals implement one CDS rule relevant to specialty or high clinical priority and track compliance with that rule.  Eligible hospitals must implement one CDS rule related to a high priority hospital condition and track compliance with that rule.  All certified EHR technologies will have the capability of implementing CDS rules and tracking compliance with those rules.

Electronic Prescribing (e-Prescribing) – E-Prescribing allows you to electronically send an accurate and understandable prescription directly to a pharmacy from your office.  It has been shown to be effective at reducing medication errors and improving the efficiency and effectiveness of care.  In addition, e-Prescribing can provide you with a patient’s medication history and formulary, insurance, and benefits information, as well as inform you of whether or when the patient’s prescriptions were filled.  E-Prescribing is a required objective for eligible professionals of the EHR Incentive Program, which requires that they generate and transmit more than 40 percent of their permissible prescriptions electronically.  Note that this measure does not require the implementation of formulary checks; instead formulary checks are a ‘menu set’ objective, of which eligible providers must choose and report on 5 menu set objectives from a list of 10.

Medication Reconciliation – Medication reconciliation can assist you in generating a complete and accurate list of all medications that the patient has been prescribed, including those prescribed by other providers and care settings.  This list is then reviewed to help identify discrepancies in drug regimens and to prevent medication errors.  As mentioned in Module One, computerized physician order entry (CPOE) and CDS functionalities can be leveraged to support medication reconciliation by capturing information from medication orders and alerting providers of duplicate medications or contraindications.  Medication reconciliation is a menu set objective of the EHR Incentive Program

Reporting – Although not required for certification under the EHR Incentive Program, some EHRs can help compile or summarize information from various parts of the medical record to identify trends in a patient population or to track compliance with clinical standards and other quality measures.  Also, some EHRs can generate reports across groups of patients to identify no-show rates or to monitor HIV genotyping and phenotyping results.  They can help you comply with mandated reporting requirements by compiling and transmitting these reports, reducing the time you spend on reporting.  This is especially the case for clinical data needed for the Ryan White System Report (RSR).  For the EHR Incentive Program, you will be expected to use your EHR system to calculate the measures you report and to submit your data electronically.

Personal Health Records (PHRs) – EHRs can be linked to PHRs to enable patients to take a more active role in their care.  These tools allow patients to view some or all of their medical record, such as lab results and medication history.  Other features that can be useful for HIV/AIDS patients include appointment reminders, medication refill requests, and secure messaging to communicate with their clinical team.  PHRs can also be linked to self-management systems and in-home monitoring devices.  Created specifically as a PHR for HIV/AIDS patients, the myHERO go to exit disclaimer PHR developed by the University of California San Francisco seeks to improve quality through increased patient engagement, self-management, better communication, and adherence.

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