1. Mapping Medications: a foundation for clinical decision support for diabetes Health Federation of Philadelphia February 29, 2016

2.  Why am I doing this?  How do I do this?  Now that I’ve mapped, how do I use it? Today’s Plan

3.  Building blocks to craft refined searches for diabetes  Support population health management  Outreach efforts  Provider engagement  Clinical decision support  Patient safety tool  Identification of outliers (providers) Why am I doing this?

4. How? Medication mapping  First, a word about Medication categories – these are a legacy from pre-EHR interface days. Don’t go there.

5. Medications  Now, check your Medications – are there Medications that represent useful groupings for your practice?

6. What you might find:

7. Disable the irrelevant!

8. Medication classes OralsInsulinsOther DM injectables ThiazolidinedionesLong-actingGLP-1 agonists SGLT2 InhibitorsShort-actingAmylin agonists Bile Acid SequestrantsNPH/fast- acting mixes Meglitinides… Sulfonylureas DPP-4 inhibitors Alpha-glucosidase inhibitors Biguanides

9. Medication grouping rationale  Identify potentially risky combinations  Distinguish evidence-based practice from not (eg metformin candidates who are not prescribed it)  Identify patients on a given therapy combination without improvement (who would be due for dose or regimen change) … I recommend mapping each class (not each medication) separately

10. Medication mapping: biguanides

12.  For a comprehensive list, refer to http://professional.diabetes.org/content/clinical- practice-recommendations, p. S55 (Table 7.1) http://professional.diabetes.org/content/clinical- practice-recommendations Finding all the right meds?

13.  Identify patients with A1c>6.5, NO metformin, and NO creatinine >=1.5 on most recent measurement. Saved in (Protocols), this search will populate the huddle sheet as “Consider metformin”. For optimal provider satisfaction, build in a metformin intolerance (‘allergy’) filter as well. Now that I’ve mapped, how do I use it?

14. (Protocols): consider insulin

15.  Prescribing the right med is only the beginning… but it can help you catch some low-hanging fruit.  Later: need to be able to capture  Adherence  Barriers  Education Is this enough?