229826 Using HIT to bridge the gap between knowledge and practice in primary care management of migraine

Tuesday, November 9, 2010 : 4:50 PM - 5:10 PM

Christa Bruce, MPH , Henry Hood Center for Health Research, Geisinger Health System, Danville, PA
Background:Chronic episodic conditions (e.g., migraine, back pain, depression) require extensive data to optimize diagnostic accuracy and treatment decision making. Primary care physicians are constrained in time available to obtain data and also lack expertise on treatment guidelines. Innovative web-based HIT tools can automate patient-reported data collection and translate guidelines into tailored and actionable advice for physicians and patients. Purpose/Objectives:To describe an integrated set of tools and workflows for managing complex, chronic episodic conditions. Methods:eMigraine is an integrated set of web applications that include a questionnaire, data exchange protocols, guideline databases, rules processors, web-based displays for physician decision support, and an application to create and print after-visit summaries (AVS). Online questionnaires are administered to patients via touchscreen computer during routine visits to capture data on headache impact and treatment. Decision rules identify patients who warrant clinical attention and process patient-reported and EHR data to identify and present specific recommendations for acute and preventive treatments. Expert recommendations are presented in a web-based display accessed via an EHR alert. A patient AVS provides education tailored to what the patient reported and the physician ordered. Results:The eMigraine pilot project will go live in spring 2010. Twelve-hundred primary care patients 18-45 years old will be randomized into an intervention group (i.e., receive all web-based protocol components) and the control group (i.e., receive an abbreviated questionnaire, no decision support, and a generic AVS). We will present preliminary comparative data on the primary measures of interest including: rate of migraine diagnosis, rate of medication prescribed for migraine (triptans, barbiturates/narcotics), and the baseline level of disability due to migraine. Discussion:HIT can aid primary care physicians in managing migraine and other complex conditions in an efficient manner that fits into current clinic work flows by automating systematic efforts to screen, diagnose, treat, and educate patients towards successful outcomes.

Learning Areas:
Chronic disease management and prevention
Communication and informatics

Learning Objectives:
By the end of the session the participant will be able to: 1. Identify key challenges for managing chronic episodic conditions in primary care 2. Describe how HIT can be used to automate patient-reported data collection and translate guidelines into tailored and actionable advice for physicians and patients. 3. Describe the preliminary comparative results (e.g., rate of migraine diagnosis by questionnaire versus EHR data) obtained from using an integrated set of HIT tools in primary care.

Keywords: Information Technology, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I implement and manage HIT projects at the Geisinger Center for Health Research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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