CHA2DS2-VASc and HAS-BLED integrated into EHR. Wow. Humility thy name is…

Yes! I am an internist. Yes! I have practiced for many years. Yes! I know about CHA2DS2-VASc and HAS-BLED*. Yes! I vaguely recalled that we installed built-in calculators right into our EHR to reduce the barriers for our docs to use these calculators while seeing patients.

No, until today, I had not actually used them in the service of a patient. I had been able to skate by with awesome colleagues doing these calculations at hospital discharge, or seeing them prior to me, and I would follow the recommendations generated by these discussions.

UNTIL TODAY! So, I typed in dot phrases to invoke CHADS and here come both calculators, fill in some quick data and see above; really awesome automatically generated displays that can be placed in patient charts (and shared with patients!), and now I can have a thoughtful discussion.

I am amazed, and humbled. In a high-functioning physician informatics organization, the CMIO should NEVER be the bottleneck. We should be innovating, improving our EHR, and balancing “good governence” (hey! don’t put all those interruptive alerts in here UNLESS those being alerted agree that this is a valuable use of their time!) with “rapid cycle innovation” (well, if the nurse leaders on that unit REALLY want to have a pop-up alert every 30 minutes, every time a heparin blood test returns, as long as the nurse leadership wants to try it…)

The innovation here is, lowering the barrier for docs to use it IN THEIR WORKFLOW within the EHR. Furthermore, to have it DISCOVERABLE! So many innovations are “hidden” (Oh, you didn’t read our monthly newsletter with 20 items? It was number 12. Oh, our newsletter went to your spam folder? Sorry about that). So, being able to type a search for CHADS or HASBLED into our search field actually teaches the doc how to use the tool. Amazing, being a customer of my own informatics team’s development. Sometimes, stuff just works.

*CHA2DS2-VASc and HAS-BLED are fantastic medical calculators that, based on scads of high quality evidence, that we can now effectively calculate the future stroke risk score of atrial fibrillation patients, AND ALSO that we can calculate the future bleeding risk of anticoagulants (having patients take blood-thinners to prevent stroke in high risk situations). And then we can have a thoughtful data-driven conversation with patients instead of licking our fingers and putting them up to the wind to see which way the wind is blowing that day. You can try it yourself; there are online calculators for CHA2DS2-VASc and HAS-BLED.

CMIO’s take? A big dose of humble pie for the CMIO is part of a good diet. What cool things have YOU discovered in your EHR?

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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