1. John Weeks1, MD Candidate 2017, Justin Hickman1, MD Candidate 2017
Impact of Implementing an Electronic Medical Record on an International Medical Mission
John Weeks1, MD Candidate 2017, Justin Hickman1, MD Candidate 2017
Camille Hochheimer2, PhD Candidate, Mark Ryan1, MD
Virginia Commonwealth University School of Medicine, Richmond, Virginia
Virginia Commonwealth University, Department of Biostatistics, Richmond, Virginia
Background
The sample analyzed consisted of adult patients who visited the clinic in 2015 (pre-EMR), as well as those who visited in 2016 (post-EMR implementation).
Data utilized included age, gender, systolic and diastolic BP, CVD risk, and up to ten medications.
Established non-laboratory CVD risk calculation charts were utilized to determine a CVD risk of Low, Moderate or High3.
Patients with High CVD risk have a 5 year risk of fatal & non-fatal events of >20%3.
Patients were considered treated for high CVD risk if prescribed a statin and treated for HTN if prescribed an anti-hypertensive.
Patients with systolic BP >140mmHg and/or a diastolic BP >90mmHg were designated as BP above goal.
Univariate logistic regression determined whether gender and/or age was significantly associated with each outcome and if so were included as a covariate in the final logistic regression.
3. Gaziano, T., Young C., Fitzmaurice G., Atwood S., Gaziano J. (2008) Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort. Lancet 371, 923–31.
Materials & Methods
30%
71%
77%
87%
Figure 1. Percentage of patients receiving treatment with a statin for high CVD risk.
Figure 2. Percentage of patients receiving treatment for HTN
Results
The sample consisted of 349 patients from (pre-EMR group) and 262 patients from 2016 (post- EMR group).
Gender and age were not significantly associated with any outcome except BP above goal and, thus, were only entered into that model.
71% of patients with high CVD risk in the post-EMR group received a statin compared to only 30% in the pre-EMR group (p<0.001).
Significantly more patients with BP >140/90 were receiving HTN treatment post-EMR vs pre-EMR (87% and 77% respectively, p=0.044).
Although 71% of patients with high CVD risk post- EMR were prescribed aspirin vs. 57% pre-EMR, this difference was not significant (p=0.066).
Discussion
Limitations / Future Directions
With the implementation of fEMR on our STMT, it was found that significantly more high CVD risk patients and patients with a BP >140/90 post-EMR implementation were receiving treatment.
This suggests that fEMR better facilitates the identification of high risk patients and their appropriate treatment.
Although more patients with a high CVD risk post-EMR were receiving aspirin, it was not significant likely due to the high prevalence of low dose aspirin use in the DR.
A longitudinal analysis might be a more appropriate way to analyze BP trends after implementation of the EMR.
A limitation of this study is that some patients could be repeat patients returning for another visit, in which case the samples from 2015 and 2016 are not truly independent.
Future analyses could include matching on age and gender, although these factors do not appear to play a major role except in the case of elevated BP.
fEMR has proven to be a powerful tool in data collection and analysis for STMTs. Next steps should include:
Further utilizing accumulated digitized data to question and research community health issues and foster new research questions.
Continued technological development of features, prompts and automation of fEMR to enhance functionality and quality of care.
Short Term Medical Trips (STMT) are often vital in bringing healthcare to underserved/under-resourced communities who may rely largely on such medical missions for their primary health care needs.
According to the WHO in all regions of the world outside of Sub-Saharan Africa, chronic disease is the number one cause of mortality1.
In the Dominican Republic (DR), 15% of patients were diagnosed with diabetes and 73% with hypertension (HTN)1.
95% of short term medical mission trips demonstrated no meaningful collection of data2.
Lack of accumulated medical data reduces quality of long term care and makes evaluation of the effects of medical missions difficult to establish.
This study examined the use of “fEMR” ( a simple portable Electronic Medical Record (EMR), and the effects of its implementation on a STMT to the DR related to the treatment of cardiovascular disease (CVD) risk factors.
Research Question
Does the implementation of a portable EMR impact quality of care and management outcomes on an STMT quantified through medical management of CVD & HTN?
Is the proportion of patients with a high CVD risk who are receiving a statin different before vs. after EMR implementation?
Is the proportion of patients with a high CVD risk who are receiving aspirin different before vs. after EMR implementation?
Is the proportion of patients with a blood pressure (BP) above goal different before vs. after EMR implementation?
Is the proportion of patients with BP above goal who are being treated for HTN different before vs. after EMR implementation?
1. Acosta, D., Rottbeck, R, Rodriguez, J, Gonzalez, L, Almanazar, M, Minaya S., Del C. Ortiz, M, Ferri, C, and Prince, M. (2010). The prevalence and social patterning of chronic diseases among older people in a population undergoing health transition. A 10/66 Group cross-sectional population-based survey in the Dominican Republic. BMC Public Health. 10,
2. Sykes, K.J. (2014) Short-Term Medical Service Trips: A Systematic Review of the Evidence. American Journal of Public Health: Vol. 104, No. 7, e38-e48.
Non-HypertensiveNon-Hypertensive 369 (58)
Hypertensive
265 (42)
Characteristic
Pre-EMR (2015)
Post-EMR (2016)
Age
52.7 (12.6)
53.6 (13.5)
Gender (% female)
73.2% (254)
73.5% (191)
High CVD risk
33.0% (105)
33.0% (75)
Receiving aspirin
34.1%( 119)
37.0% (97)
Receiving a statin
16.1% (56)
32.4% (85)
HTN treatment
49.9% (174)
60.3% (158)
Systolic BP
138.3 (25.1)
136.6 (24.9)
Diastolic BP
85.0 (14.9)
83.6 (13.7)
Table 1. Characteristics of the Pre and Post EMR Groups - mean(std) or percentage(n)
89 (33)
Outcome OR
95% CI
p-value
Receiving a statin
5.75
3.00
11.02
<0.001
Receiving aspirin
1.81
0.96
3.39
0.066
BP above goal
0.72
0.51
1.02
0.068
HTN treatment
2.09
4.29
0.044
Acknowledgments
DEPARTMENT OF BIOSTATISTICS
Table 2. Odds ratios comparing post-EMR to pre-EMR patients