EVMS/Sentara study shows value of combining electronic medical records with latest diabetes treatment advice

Story Date: Tue, 07 May 2013 09:51:00 EDT

A new approach to combine the latest diabetes-treatment guidelines with an electronic medical records system (EMR) has helped patients achieve marked improvement in managing their disease during a recent 10-month study.

The study was a cooperative effort of Sentara and EVMS and demonstrates the benefits of using electronic alerts to notify physicians of changes in patient status and proven protocols of care. Sentara physicians worked with a diabetes expert from the EVMS Strelitz Diabetes Center to help consistently adopt guidelines to improve outcomes for Sentara diabetes patients. The results were presented May 2 in Phoenix at the 22^nd annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (AACE).

AACE has established guidelines for diabetes management, such as what to do when a patient is first diagnosed or when his or her blood sugar exceeds a given level. However, implementing these guidelines is always challenging, says Joseph A. Aloi, MD, Clinical Director of the EVMS Strelitz Diabetes Center and an expert in the care of people with diabetes. Typically, half of U.S. diabetes patients fail to achieve goals for controlling key aspects of diabetes: blood sugar levels, blood pressure and lipids.

Managing chronic disease through Sentara Medical Group is part of a larger effort to transform care at Sentara, an integrated health system in Norfolk, Va. Sentara assembled a team that worked with the 154 primary care providers in Sentara Medical Group to develop a way to deliver the right diabetes care at the right time to improve patient outcomes.

Sentara reached out to the EVMS Strelitz Diabetes Center to join the team. Using AACE guidelines, EVMS’ Dr. Aloi, working in concert with other endocrinologists and primary care physicians, helped the team develop alerts that are triggered in the EMR when a change occurs in a patient’s condition. The alerts offer guidance about the appropriate care for that situation. For example, during an office visit with a patient, through the EMR a physician could be alerted to abnormal lab results and be prompted to review the patient’s oral medications, begin insulin therapy or refer the patient to a specialist.

The new system uses the best medical evidence to help primary care physicians standardize care for diabetes patients as well as more consistently refer to a specialist when needed.

Sentara piloted the new approach in two primary care practices and one endocrine site prior to implementing it at 11 additional Sentara Medical Group primary care sites treating patient with diabetes.

During the study period, patients showed substantial improvement. Nearly 900 patients moved from the highest level of risk for complications to a healthier range.

“To truly transform health care takes a community of partners. We’re fortunate to have physicians at Eastern Virginia Medical School working with us to tackle the complexities of diabetes to improve the lives and care of our patients,” says David Maizel, MD, President of Sentara Medical Group.

“This represents a true team effort for real-time identification of patients at higher risk for diabetes complications,” says Jerry L. Nadler, MD, Director of the EVMS Strelitz Diabetes Center, Chair of Internal Medicine at EVMS and the Harry H. Mansbach Chair in Internal Medicine. “The integration of this technology allows the physician to transform an office visit into an opportunity for better diabetes management.”