1. SPHERE Stroke Prevention in Healthcare Delivery Environments SPHER E Real-time data-driven tools for clinicians: A model for extending functionalities within the electronic health record Stroke Prevention in Healthcare Delivery Environments Randi Foraker, PhD Marcelo Lopetegui, MD Jeremy Harper, MBI David Irwin, BA Philip Payne, PhD @randi_epi #EDM14

2. SPHERE Stroke Prevention in Healthcare Delivery Environments Funding source: Pfizer, Inc. We have no other relevant disclosures D ISCLOSURES

3. SPHERE Stroke Prevention in Healthcare Delivery Environments B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

4. SPHERE Stroke Prevention in Healthcare Delivery Environments Adverse health behaviors and factors reduce cardiovascular health (CVH) and increase risk of cardiovascular disease Advances in health information technology (HIT) provide an opportunity to automate assessment of these factors and intervene across a population The overall aim of the SPHERE study is to decrease the burden of stroke and its modifiable risk factors among older women in primary care B ACKGROUND

5. SPHERE Stroke Prevention in Healthcare Delivery Environments S IGNIFICANCE B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

6. SPHERE Stroke Prevention in Healthcare Delivery Environments S IGNIFICANCE Heart disease is the leading cause of death in the US Less than 1% of the US population are in ideal CVH A comprehensive, automated CVH assessment deployed in the primary care setting offers the potential to:  Facilitate patient-provider communication  Enhance prevention  Reduce stroke risk

7. SPHERE Stroke Prevention in Healthcare Delivery Environments I NNOVATION B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

8. SPHERE Stroke Prevention in Healthcare Delivery Environments I NNOVATION Generates visualizations of the CVH score within the electronic health record (EHR) Platform-independent and scalable Empowers clinicians to discuss prevention with patients May affect change in average CVH score at the clinic level

9. SPHERE Stroke Prevention in Healthcare Delivery Environments L IFE ’ S S IMPLE 7 TM B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

10. SPHERE Stroke Prevention in Healthcare Delivery Environments L IFE ’ S S IMPLE 7 TM Manage blood pressureStop smokingControl cholesterolReduce blood glucoseLose weightGet activeEat better Life’s Simple 7 TM

11. SPHERE Stroke Prevention in Healthcare Delivery Environments L IFE ’ S S IMPLE 7 TM Poor HealthIntermediate HealthIdeal Health Health Behaviors Smoking statusCurrentFormer ≤ 12 monthsNever or quit > 12 months Body mass index≥ 30 kg/m 2 25 - 29.9 kg/m 2 < 25 kg/m 2 Physical activityNone 1-149 min/wk moderate or 1-74 min/wk vigorous or 1-149 min/wk moderate + vigorous ≥ 150 min/wk moderate or ≥ 75 min/wk vigorous or ≥ 150 min/wk moderate + vigorous Healthy diet score0 – 1 components2 – 3 components4 – 5 components Health Factors Total cholesterol≥ 240 mg/dL 200-239 mg/dL or treated to goal < 200 mg/dL Blood pressure Systolic ≥ 140 mm Hg or Diastolic ≥ 90 mm Hg Systolic 120-139 mm Hg or Diastolic 80-89 mm Hg or treated to goal Systolic < 120 mm Hg Diastolic < 80 mm Hg Fasting plasma glucose≥ 126 mg/dL 100-125 mg/dL or treated to goal < 100 mg/dL

12. SPHERE Stroke Prevention in Healthcare Delivery Environments S TUDY P OPULATION B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

13. SPHERE Stroke Prevention in Healthcare Delivery Environments S TUDY P OPULATION Female patients aged 65 years and older and their primary care providers Eligibility does not depend upon presence of cardiovascular risk factors

14. SPHERE Stroke Prevention in Healthcare Delivery Environments S TUDY P OPULATION

15. SPHERE Stroke Prevention in Healthcare Delivery Environments SPHERE APP B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

16. SPHERE Stroke Prevention in Healthcare Delivery Environments SPHERE APP Patient Encounter in IHIS Clinical Database Collected by EHR Information Warehouse SPHERE Data Mart Patient Survey Tools Stored To Exported To Materialized As Optional Source of Additional Data BPA w/Link to Project-Specific Web Application Triggers Invokes SPHERE Web Application Risk Profiling Algorithm Patient-Specific Risk Profile Data Conciliation Visualization of Interactive Risk Report @ point-of- care Supplies Encounter Data Request Historic Data Deliver s Updates on interaction Foraker RE, Shoben AB, Lopetegui MA, et al. Assessment of Life's Simple 7™ in the primary care setting: The Stroke Prevention in Healthcare Delivery EnviRonmEnts (SPHERE) study. Contemp Clin Trials. In press.

17. SPHERE Stroke Prevention in Healthcare Delivery Environments SPHERE APP Displays in a non- obtrusive, asynchronous panel in the EHR Built-in functionality (slider bars) demonstrate how a change in each of the input variables changes the patient’s CVH score

18. SPHERE Stroke Prevention in Healthcare Delivery Environments R ESULTS B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

19. SPHERE Stroke Prevention in Healthcare Delivery Environments R ESULTS *Diabetes was defined as either treated by a glucose-lowering medication (intermediate) or not (ideal). CVH* of older female patients (n=160) in primary care

20. SPHERE Stroke Prevention in Healthcare Delivery Environments R ESULTS  Patients averaged 74 years old, and 35% were black  Mean CVH score was 6.0  Mean fractional score (actual score/maximum possible) was 0.63  Greater than 10% of data were missing for body mass index (13%) and cholesterol (11%)

21. SPHERE Stroke Prevention in Healthcare Delivery Environments D ISCUSSION B ACKGROUND S IGNIFICANCE I NNOVATION L IFE ’ S S IMPLE 7 TM S TUDY P OPULATION SPHERE A PPLICATION R ESULTS D ISCUSSION

22. SPHERE Stroke Prevention in Healthcare Delivery Environments D ISCUSSION Public health implications  Older female patients seen in the primary care setting have less-than-ideal CVH  Great potential to leverage the EHR for patient-provider communication and engagement around prevention  May modify approach to incorporate other guidelines into the primary care setting Clinical implications  A majority of Life’s Simple 7™ components are easily queried from EHRs  Able to automate evidence-based risk calculations across our patient population  Ongoing workflow and usability analyses will help us update and optimize the app

23. SPHERE Stroke Prevention in Healthcare Delivery Environments SPHER E Real-time data-driven tools for clinicians: A model for extending functionalities within the electronic health record Stroke Prevention in Healthcare Delivery Environments Randi Foraker, PhD Marcelo Lopetegui, MD Jeremy Harper, MBI David Irwin, BA Philip Payne, PhD @randi_epi #EDM14