Improving the Quality of Our Clinical Work for Coumadin Anticoagulation Therapy with Electronic Medical Record (EMR) Based System Redesign

Coumadin anticoagulation therapy is indicated in a variety of thromboembolic conditions. Close INR monitoring is required to maintain therapeutic range in order to decrease complications, emergency room visits, and medical costs associated with Coumadin therapy. To achieve this, tight quality control in primary health care systems is undeniably important. The purpose of this study is to assess the effects of a redesigned system for coumadin anticoagulation therapy in an outpatient setting. Our project includes: (1) Meaningful use of a new electronic medical record (EMR) based INR flow sheet; (2) Improved physician and staff efficiency using new EMR based protocol for INR tracking and clinical decision support, including drug interaction information, dose adjustment, per-procedure anticoagulation bridging, and an education/training program; (3) Improved patient education, including enhanced Coumadin educational materials. Vitamin K prescriptions will be given to the patients in the event of complications with coumadin.

INR data were collected from 55 patients receiving Coumadin therapy from 10/01/2009 to 10/31/2011 at an outpatient setting. Total blood tests for INR were 1679 samples. We summarized results from 55 patients twelve months before and after using our redesigned system.

Our data shows the new system helped to: (1) Increased the percentage of INRs (average) in the therapeutic range from 51.35% to 54.05% and the percentage of INRs (average) in extended therapeutic range (+/−0.2) from 63.78% to 70.43%; (2) Decreased the highest value from 15.4 to 10.2; (3)Decreased annual total number of INR checkups for all patients from 881 to 798; and (4)Decreased average number of INR checkups per month from 1.8 to 1.3 (average).

Our clinical data shows that Our EMR based system redesign not only helps to increase efficiency and safety of Coumadin anticoagulation therapy, but also decreases the frequency of INR checks, thereby reducing medical expenditures.

No relevant conflicts of interest to declare.