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Leveraging EHRs to Close Gaps in Postmenopausal Osteoporosis Care · Becker’s Healthcare Podcast

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  Hello, everyone. This is Erica Spicer Mason with
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  Becker's Healthcare. Thank you so much for tuning
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  into the Becker's Healthcare podcast series today.
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  So today's episode continues an important conversation
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  on osteoporosis,
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  shining a spotlight on how health systems can
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  leverage new features within their EHR systems to
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  improve care for postmenopausal
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  osteoporosis
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  patients.
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  This episode is sponsored by Amgen.
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  And with that, I will turn the floor
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  over to Amgen's
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  Kristen Buseman, the director of IBM strategy and
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  marketing. Kristen, take it away.
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  Hello, everyone. It's a pleasure to be back
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  here on the Becker's podcast again. So my
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  name is Kristen Buseman, and I am the
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  health systems and key accounts marketing director at
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  Amgen for the US bone health franchise.
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  My team and I are really focused on
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  how we can understand challenges and opportunities to
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  improve osteoporosis diagnosis and treatment for patients,
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  particularly those that have experienced a fracture.
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  We're always happy to talk to leaders from
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  health systems to better understand their challenges and
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  to learn about strategies and solutions they're using
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  to improve the health of this patient population.
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  So today, I'm really excited to be speaking
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  with doctor Barry Wendt from St. Elizabeth Healthcare.
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  Doctor Wendt, would you like to introduce yourself
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  for our listeners?
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  Absolutely. I'm doctor Barry Wendt. I'm a practicing
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  internist, and I am the chief medical information
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  officer at St. Elizabeth Healthcare.
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  Great. Thanks so much for joining me today
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  to have this conversation.
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  You know, we're really looking forward to seeing
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  how you have been, incorporating
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  advances in electronic health records to improve postmenopausal
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  osteoporosis
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  care and just population health management in general
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  at St. Elizabeth.
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  So let's jump right in. Before we get
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  into the details, can you share a little
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  bit of background on Saint Elizabeth Healthcare and
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  about the burden of osteoporosis that you've witnessed
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  across your health system?
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  Absolutely.
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  So Saint Elizabeth Healthcare is a Catholic
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  institution that was started in the eighteen hundreds.
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  Like many,
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  Catholic health care institutions in
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  the Midwest,
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  founded by a a group of nuns. And,
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  we've now,
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  significantly expanded. We have,
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  five
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  hospitals,
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  one in Southeast Indiana and,
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  the rest in Northern Kentucky. And we're just
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  across the river from Cincinnati.
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  We have a physician group, multi specialty group,
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  that, has more than 800 providers
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  and 250
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  or I'm sorry, 2,500
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  associates.
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  We have been, distinguished with the, unique
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  award by US News and World Report of
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  being the number one hospital in Kentucky, and,
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  I'm happy to say in the ninety ninth
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  percentile for physician satisfaction with their EMR.
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  So for osteoporosis,
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  you know, as a primary care physician,
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  I see
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  a variety of disorders,
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  postmenopausal
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  osteoporosis
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  being one of those, that I see almost
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  on a daily basis.
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  And the challenging thing is many women are
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  undertreated,
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  and, we find that even though they're diagnosed,
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  sometimes they're just put on
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  calcium, vitamin d, and given exercise, but not
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  really put on the adequate therapy that they
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  need.
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  So that's a significant problem.
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  After osteoporosis
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  related fractures,
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  postmenopausal
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  women are five times more likely to suffer
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  another fracture,
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  and that risk remains high through the extent
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  of their lifetime.
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  And what we're finding is many providers just
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  can't keep up with the guidelines.
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  In the last ten years, there have been,
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  three
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  new novel classes of drug
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  and, many drugs released to market, and and
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  the guidelines have changed. And with all the
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  things you have to do in primary care
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  and in many specialties, it's very hard to
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  keep up. So
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  we're trying to find novel ways to get
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  providers
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  to see the guidelines and pay attention to
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  those and to be able to evolve with
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  that. And so we're we're trying to get
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  our providers to focus on when it's important
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  to get a DEXA scan and when it's
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  important to initiate treatment
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  and to work on fall prevention.
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  Thanks so much, doctor Windt. And,
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  congrats to the team at St. Elizabeth. Sounds
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  like you guys are doing great work there.
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  And, you know, your comments on the challenges
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  faced in treating the osteoporosis patient population
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  ring true to me as I talk to
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  folks across across the nation.
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  I know in your role as CMIO at
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  Saint Elizabeth, you're really a champion of integrating
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  EHR solutions to help address some of those
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  care gaps that you were just mentioning.
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  Can you tell us a little bit about
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  diagnosis aware notes or or they're referred to
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  DANS. Is that right? That's correct.
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  So how what are DANS? How do they
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  function within an EHR, and how can they
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  really help people?
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  So several years ago, Epic,
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  our EHR,
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  came up with, something called problem oriented charting.
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  And that allowed providers to do their documentation
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  based on problems.
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  And one of the great breakthroughs with that
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  was they incorporated something called diagnosis aware notes,
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  which is notes that follow a more natural
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  workflow for the provider. They can, document the
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  way they did years ago with,
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  writing on paper,
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  in a natural workflow.
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  And we were able to take some
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  smart text and associate that with certain diagnoses.
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  And that smart text drops in automatically
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  and allows them to do their
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  documentation much more efficiently.
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  And embedded within that smart text,
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  we're able to put
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  guideline driven decisions,
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  that nudges providers to do the right thing.
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  And it will,
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  sort of
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  guide them right through the the clinical guidelines
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  and,
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  provide,
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  kind of a template for them to use.
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  It's greatly sped up documentation time. And, the
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  nice thing is we don't have to rely
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  on BPAs
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  that have been a a sort of a
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  pain for many of providers.
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  That's great. So they're they're kind of like
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  a a soft BPA, if you will.
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  Yeah. The the great thing is is is
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  it's decision making
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  within that smart text.
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  So it walks them through the guidelines
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  as they're going their note. And that,
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  not only does it greatly speed up their
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  time documenting, but it, reduces their cognitive effort
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  that they have to use
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  in remembering now what is it I do
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  for this diagnosis and and what are the
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  guidelines on this.
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  It it walks them right through that, and,
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  and it it nudges them to the right
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  decisions.
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  That's great. So it sounds like you were
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  really an early adopter of DANS.
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  You know, and it sounds like you were
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  kind of thinking about what would would really
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  benefit your providers across your system.
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  You know, as you've introduced those DANS across
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  the system, how's that really changed the way
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  osteoporosis
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  is being treated and managed?
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  Can you share any specific examples?
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  Yeah. So physicians have asked me to, you
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  know, enhance these, make more of these, you
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  know, not just for osteoporosis for many diagnosis.
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  But it does, help with that decision making,
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  and I I think we're finding much more
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  compliance
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  with the guidelines than we were
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  prior to having these in place.
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  That's great. And I'm I'm sure that there
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  are other advantages too in terms of, like,
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  making sure that all the right documentation
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  is in place,
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  you know, to assist kind of patient follow-up
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  and things like that as well. One example
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  is vitamin d levels are,
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  incorporated into the documentation. So if a patient
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  hasn't had a vitamin d level checked, then
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  the provider is immediately aware that that's not
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  there and will place an order. So
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  it also has,
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  you know, some of the guidelines on,
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  exercise and things like that incorporated in there.
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  So it it really has enhanced the care
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  we provide. Well and I know that,
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  there's a lot of care gaps for these
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  osteoporosis
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  patients, especially after a fracture. So it sounds
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  like this is a really great way to
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  help,
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  keep their care coordinated
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  and simplify things for the providers as well.
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  So one question for you on behalf of
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  our listeners here is, what advice would you
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  have to folks that would be interested in
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  including and incorporating DANS into their workflows?
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  That's a great question.
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  So diagnosis aware notes are
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  extremely easy to use, and associating a smart
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  text with the diagnosis is also very simple.
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  I would say it takes less time to
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  read the guidelines than it does to build
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  these inside our our EHR.
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  So first, you you basically
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  build out the the template of what you
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  want it to,
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  fit to the guideline and then associate it
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  with a grouper for that specific diagnosis.
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  For example, diabetes.
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  You you would associate it with a diabetes
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  grouper within our EHR,
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  and then automatically that smart text will drop
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  in.
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  And, and then it is basically just,
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  creating that nudge architecture.
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  Usually, we put the preferred medications at the
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  top of the list, and the preferred items
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  are defaulted in. So it's very easy to
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  build,
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  takes minutes, really, to to build these out.
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  That's great. That's great. So let's take a
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  step back and look at the bigger picture
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  here. What challenges have you faced in integrating
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  new technology into existing health care practices, and
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  what future developments or improvements would you like
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  to see in EHR systems to further enhance
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  patient care?
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  Yeah. I think the challenges have been providers
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  don't like disruptions during their workflow.
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  And the great thing about these is they're
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  nondisruptive,
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  unlike the the pop up BPAs or even
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  the soft BPAs that, Epic has put into
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  what's called the storyboard.
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  That's become more or less a a distraction,
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  because there's so many things now put into
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  the storyboard. So this is a way of
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  getting our providers to do the right thing
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  by putting it into their natural workflow.
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  So that's that's one great advantage.
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  One of the challenges I think that we're
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  gonna face is all the AI
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  that's creeping into health care. And the problem
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  I see is that, the AI might not
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  pick up the appropriate guidelines or might not
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  walk you through
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  the steps the way these do. These are
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  these are truly
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  curated steps
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  to walk the provider through that encounter.
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  And, I'm concerned a bit that that we're
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  gonna be too reliant on AI, and AI
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  might not provide the the correct answer. So,
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  I think that's that's where I see these
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  of having a significant advantage, and I think
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  they're gonna be around the state for a
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  while.
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  Right. So what I'm hearing is we need
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  to, be using technology resources and innovations, but
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  it needs to be informed by by clinical
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  guidelines and and
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  the knowledge of our provider community.
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  So this has been really great, doctor Wendt.
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  We really appreciate these helpful insights. I know
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  this is an area that is of interest,
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  not just for
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  providers that are treating and and managing osteoporosis
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  patients, but, beyond. So thanks so much for
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  your insights.
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  And, thanks to the Becker's team for letting
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  us be on your podcast again. Stay tuned
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  for more insights on advancing post fracture care
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  and postmenopausal
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  osteoporosis
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  from Amgen. And, thanks so much for our
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  listeners for tuning in.
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  Well, thank you so much, Kristen and doctor
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  Wendt, for your time and this insightful conversation
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  today. It's been a pleasure having you both
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  on the podcast. And, of course, we'd also
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  like to thank today's sponsor,
• 11:47
  Amgen.
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  Listeners, please be sure to tune into more
• 11:50
  podcasts from Becker's by visiting our podcast page
• 11:53
  at beckerspodcast.com.
• 11:56
  This podcast was sponsored by Amgen. Participants have
• 11:59
  been compensated for their time by Amgen.