Mequal-heart record in combination with the Heart Manual Hans Tygesen, MD, PhD Head of Cardiology Department of Medicine SÄS International forum on quality and safety in healthcare
The Heart Manual Local guidelines for heart disease treatment Yearly update, now 230 pages Everyone can contribute National and european latest guidelines included
Mequal-MEdical QUALity or Medical EQUALity Computerized decision & workflow support in Cardiology
History
Demands of documentation increases Notes for personal use Information shared with other care givers Legal document
History
Computerised record Text based; computerised paper record Simple-dictate as usual
Example Risk profile: Known hypertension. No Keywords hyperlipidemia. Smokes 15 cigarettes daily. Moderate alcohol consumption. Blood pressure: 140/90. Uncoordinated text
Personal background Clinical active cardiologist Research; PhD and international multicenter trails Recording study patient CRF
Heart record 2003 Standard care plan for ischemic heart disease Including clinical physiology and procedures Process oriented Quality registries as templates Data stored atomically Counteracting redundant data
Heart record 2003 Quality check» Compulsory data» Check for completeness Possibility for searching data Quality check of data exported to quality registries Decision support QUICC
Export to the quality registry of myocardial infarction 4 pages, about 110 entries for each patient
Decision support QUICC A national quality insurance project 5 treatments/procedures were selected ACE-inhibitors, lipid lowering treatment, clopidogrel, LMVheparin, coronary angiography
ACE-inhibitor treatment Systolic heart failure Clinical signs of heat failure Diabetes Hypertension
Borås Quicc-results 2003. Before and after decision support ACE-hämmarbehandling 100% 80% 60% 40% 20% 0% Före Fått avsedd behandling Efter Ej fått behandling
Borås Quicc-results 2003. Before and after decision support ACE-hämmarbehandling 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Före Efter Fått avsedd behandling Fått avsedd beh, ej registrerad Kontraindikation föreligger Ej fått behandling
Borås Quicc-results 2003. Before and after decision support
Accordance to guidelines in Västra Götaland 2002-08 100% 90% 80% 70% 60% 50% Borås Övriga VG 40% 30% 20% 10% 0% jan-02 jan-03 jan-04 jan-05 jan-06 jan-07 jan-08
Gender differenses in treatment are reduced when using decision support? In a recently published paper we demonstrated less accordence to guidelines when treating women in the Western region 1998-2014 We do not see those differences in data from Borås 2004-2013 for ACE-inhibitors
Hazards / limitations using decision support Users have to be well informed and accepting guidelines More difficult to apply when several groups are involved More difficult to apply when the decision process is taking some time Treatment changes can be done fast- dangerous if the new treatment turns out to be harmfull
Futher development Regional project 2011-15 Developing standard care planes for other diseases as atrial fibrillation, heart failure and pneumonia Online-export to quality registry RIKS-HIA New decision support for atrial fibrillation and heart failure
Standard care plan for myocardial infarction
Exportapp RIKS-HIA
New decision supports Heart failure New heart failure treatment 94-98% adherence Atrial fibrillation Anticoagulation
Anticoagulation in atrial fibrillation
Future Futher regional development has stopped last year Mequal is used in Borås A lot of quality data is being extracted and analysed; to become better we have to know how we are performing to day!
Thank you! References Clinical decision support system (CDSS)--effects on care quality. dos Santos MA, Tygesen H, Eriksson H, Herlitz J. Int J Health Care Qual Assur. 2014;27(8):707-18. Trends in Gender Differences in Cardiac Care and Outcome After Acute Myocardial Infarction in Western Sweden: A Report From the Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). Redfors B, Angerås O, Råmunddal T, Petursson P, Haraldsson I, Dworeck C, Odenstedt J, Ioaness D, Ravn-Fischer A, Wellin P, Sjöland H, Tokgozoglu L, Tygesen H, Frick E, Roupe R, Albertsson P, Omerovic E. J Am Heart Assoc. 2015 Jul 14;4(7). pii: e001995. doi: 10.1161/JAHA.115.001995.