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Heart Risk Calculator

 

Summary

The team created a tool to provide personalized, interactive heart risk information in patient electronic health records.


Team

MedStar Health National Center for Human Factors in Healthcare


Background

In November 2018, the MedStar Health National Center for Human Factors in Healthcare was awarded $2 million in combined cooperative agreement funding from the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) for Health Information Technology to accelerate health IT interoperability as part of the Leading Edge Acceleration Projects (LEAP) in Health IT opportunity.

Since that time, the MedStar Health human factors team has been working with Centra Health, CareJourney, Asymmetrik, MedStar Health’s electronic health record (EHR) vendor, a patient advocate, and many within the MedStar Health system to transform the stand-alone Million Hearts® risk calculator for heart disease, stroke, and cardiovascular disease into an active surveillance tool that physicians can use in the EHR system to streamline and improve patient care. Known more precisely as the Atherosclerotic Cardiovascular Disease (ASCVD) 10-Year Risk Calculator, the tool estimates the risk of having a heart attack or stroke within 10 years. American College of Cardiology and American Heart Association guidelines encourage U.S. doctors to use it to help guide treatment options for their patients. Considered the “gold standard” risk calculator, doctors originally needed to navigate to the ASCVD Risk Estimator website and enter patient information into this stand-alone tool to use it. Furthermore, if they wanted to show how specific lifestyle choices might impact that risk over time, they may choose to use yet another separate application or patient education materials. 

 

Idea

Since many EHRs don’t include a risk estimator or don’t do so prominently, MedStar Health has developed a heart risk calculator application (app) in the EHR that doctors can use to access the ASCVD Risk Estimator, document risk, and teach their patients how to lower risk. The MedStar Health heart risk calculator app has two components: The ASCVD Risk Estimator, a clinician-facing tool, and the ASCVD Risk Educator, a patient education tool.

This video shows both components through an example of a patient who is high-risk for having a heart attack or stroke within 10 years.

Interfacing with a patient’s chart, the “Risk Estimator component of the app auto-populates with the relevant lab values and patient information, generating a 10-year ASCVD risk score. Before the app, a doctor would have to search for each data point in the EHR then use an online calculator or mobile app to access the estimator. The cumbersome process of going back and forth between the patient chart and the calculator increased clinician burden and introduced the risk for errors. All information in this new MedStar Health tool is pre-populated, which is a major advancement and time-saver and strives to reduce clinician burden and risk for errors through integration into clinical workflow. 

Here’s a snapshot of the benefits of MedStar Health’s heart risk calculator Risk Estimator: 

  • Calculate and recalculate scores: Patient data are auto-populated from the EHR, pulling in the most recent and relevant values. Scores that are unable to be calculated are visually flagged.
  • Date stamps: Lab values are time-stamped with the date of data capture and are viewable through a hover function.
  • Documentation: A summary relating to the patient’s displayed risk score is produced and can be copied and pasted anywhere in the doctor’s EHR note.
  • Link to clinical guidelines: This tool also links to the American College of Cardiology and MedStar Health clinical guidelines for managing cardiovascular risk at the bottom of the display.

The doctor can then use the “Risk Educator” component of MedStar Health’s heart risk calculator to help patients understand what to do about their risk. In this video example, getting the patient’s blood pressure into the normal range drops the estimated risk from 30.7% to 24.2%. Improving cholesterol with some dietary changes might not have a significant impact, but preventing diabetes makes a huge difference in the estimated risk. Overall, this aspect of the tool allows the clinician to manipulate auto-populated patient data to calculate and recalculate risk scores for the purpose of patient education, inviting the patient to watch the dynamic process in the EHR.  

Impact

In February 2020, during American Heart Month, an estimated 575 cardiology, primary care, family medicine, and endocrinology doctors across the MedStar Health system introduced the heart risk calculator to patients. The application is enabling doctors to more easily show patients their personal risk for heart disease, stroke, and other cardiovascular diseases over time, as well as lifestyle choices that can improve heart health, using easy-to-read graphics. 

In parallel, MedStar Health’s human factors experts are evaluating the effectiveness of the new application in improving care, processes, and outcomes, and further optimizing the tool as insights are gathered. If the tool is as successful as anticipated within the system, these experts will explore the potential for other healthcare platforms and providers nationwide to begin using the heart risk calculator. This possibility to scale nationally is fueled by the MedStar Health Human Factors Center’s growing capabilities in informatics and SMART on FHIR app development, which are complemented by the team’s foundation in human factors and commitment to designing tools for and with end users.

Additionally, within MedStar Health, the human factors team will explore the case and approach for developing further educational materials that patients can take home.  

Heart Risk Calculation: The “ASCVD Risk Estimator” aspect of the MedStar Health heart risk calculator app is intended as a quick reference for the physician to calculate a patient’s ASCVD 10-year risk from the information collected within the EHR. This is the first view of the application, which is prominently displayed in the EHR.
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Heart Risk Education: The dynamic “Risk Educator” component of the MedStar Health heart risk calculator is designed for physicians to use during a patient examination as a visual aid to augment risk education provided to patients. It is dynamic so that the physician can manipulate values to illustrate how 10-year ASCVD risk may change with certain medical or lifestyle interventions. It is designed to also serve as a decision-making aid for clinicians.
Click image to enlarge

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Please note: Images on this page contain fictitious patient data or are otherwise altered for confidentiality.

The overview above reflects work completed while the MedStar Health National Center for Human Factors in Healthcare was part of the MedStar Institute for Innovation. In July 2020, the Human Factors Center transitioned to its new organizational home, MedStar Health Research Institute, and still remains a key collaborator of MI2. Visit the Human Factors Center website for the latest information on its work.