Urology & Kidney Disease News Fall 2009 - Cleveland Clinic

46 Urology & Kidney Disease News
Chronic Kidney Disease
Optimal Use of the Electronic Medical Record in Chronic Kidney Disease
Joseph V. Nally, Jr., MD
Enrollment of patients in our Chronic Kidney Disease
(CKD) Clinic and use of the electronic medical record
(EMR) permitted establishment of a CKD database of the
demographics, clinical parameters and outcome measures
of these patients. In addition, the EMR-based database
was used for identifying and enrolling patients in clinical
research projects.
We are now embarking upon a more ambitious project to
examine the role of the EMR in the identification and management
of CKD patients throughout our health system.
The development of a CKD Registry is the initial objective of
a comprehensive program to develop an EMR-based disease
management model for the care of patients with CKD.
The other objectives for this comprehensive program are
to: a) implement clinical decision tools (Physician Alerts)
within the EMR based upon clinical guidelines in CKD
management, b) measure the utility and impact on quality
of care and cost of these CKD tools (Physician Alerts) upon
management of CKD patients, and, c) determine the potential
barriers of physician acceptance to these clinical decision
tools (Physician Alerts).
The CKD Registry has recently identified nearly 40,000
patients with CKD who have received their medical care
at Cleveland Clinic since January 2005. Patients with CKD
were identified from the Cleveland Clinic EMR/Epic based
upon: a) an eGFR < 60mL/min, (measured in outpatients at
least twice in an interval > 3 months), or b) an ICD-9 Diagnostic
Code for kidney disease such as diabetic nephropathy,
polycystic kidney disease, glomerulonephritis, hypertensive
nephrosclerosis, etc. Data elements within the CKD
Registry include:
anemia management, calcium, phosphorus, PTH,
Vitamin D, lipids, etc.
and its risk factors.
Key Points:
We are developing a Chronic Kidney Disease Registry from
our electronic medical records and CKD Clinic. The information
and observations learned from our CKD Registry should
be hypothesis-generating for the development of our comprehensive
CKD Model of Care Program.
Based upon our insights into the management of CKD, we
plan to implement clinical decision tools within the EMR
based upon clinical guidelines in CKD management. We
have initiated a collaborative effort with our colleagues in
Primary Care and Quantitative Health Sciences to develop
involved in the care of CKD patients.
Our CKD Registry will also interface with the USRDS and
the Social Security network.It is uniquely designed to examine
the recognition and management of CKD in patients
over the entire care spectrum ranging from the primary care
environment, traditional nephrologic care, CKD Clinic, and
renal replacement therapy with either dialysis or transplantation
via the USRDS. Our CKD Registry will help us address
the following issues regarding the scope of CKD and
its management:
1. Prevalence of CKD by stage within Cleveland Clinic.
2. CKD recognition by physician and the healthcare team.
3. CKD progression with loss of GFR over time. The goal
of this area will be to produce a “CKD progression tool”
for use by physicians, healthcare teams, and patients in
preparing for future CKD needs such as education, vascular
access, or renal replacement therapy.
4. Assess “Processes of Care” by the physician regarding
the ordering of appropriate assessment related to: hypertension,
anemia, hyperlipidemia, PTH, etc.
5. Assess “Clinical Practice Measures Targets” related to
the management of hypertension, anemia, hyperlipidemia,
hyperparathyroidism, etc.