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Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure

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Abstract

Purpose

A majority of clinical decisions use the electronic health record (EHR) and there is an unmet need to use its capability to help providers to make evidence-based decisions that improve care for heart failure patients. These electronic nudges are rooted in the human psychology of decision-making and often target specific cognitive biases. This review outlines the development of novel EHR nudges and specific lessons learned from each experience to inform the development of future interventions.

Recent Findings

There have been several randomized clinical trials examining the impact of EHR alerts on quality of care for heart failure patients. These interventions have targeted both clinicians and patients. There are features of each trial that inform best practices and future directions for EHR nudges.

Summary

Recent clinical trials have demonstrated that some EHR alerts can improve care for heart failure patients. These trials utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow. Alerts aimed at improving care should be examined in a randomized fashion in order to evaluate their impact on clinician satisfaction and patient care.

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Authors and Affiliations

  1. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, 06517, USA

    Michael A. Fuery, Marc D. Samsky, James V. Freeman, Katherine Clark, Nihar R. Desai & Tariq Ahmad

  2. Clinical and Translational Research Accelerator (CTRA), Yale School of Medicine, New Haven, CT, USA

    Bashar Kadhim & Francis P. Wilson

  3. Yale Center for Customer Insights, Yale School of Management, New Haven, CT, USA

    Treeny Ahmed

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  1. Michael A. Fuery
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Correspondence to Tariq Ahmad.

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Conflict of Interest

Michael Fuery, Marc Samsky, Katherine Clark, Treeny Ahmed, Bashar Kadhim declare that they have no conflict of interest.

F. Perry Wilson is supported by R01DK113191 and R01HS027626 and has received research support from Whoop, Inc., AstraZenca, Amgen, Boeringher-Ingelheim, and Vifor Pharma.

Dr. Freeman reports salary support from the American College of Cardiology (ACC) National Cardiovascular Data Registry and the NHLBI and consulting/advisory board fees from Boston Scientific, Medtronic, PaceMate, and Biosense Webster. He has equity in PaceMate.

Nihar Desai works under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures used for public reporting and pay for performance programs. He reports research grants and consulting for Amarin, Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Novartis, SCPharmaceuticals, and Vifor.

Tariq Ahmad has received consulting fees from Sanofi, Amgen, and Cytokinetics, and has received research funding from Boehringer Ingelheim, AstraZeneca, Cytokinetics, and Relypsa.

All authors report that no relationships are relevant to the contents of this manuscript.

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Fuery, M.A., Kadhim, B., Samsky, M.D. et al. Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure. Curr Heart Fail Rep 20, 280–286 (2023). https://doi.org/10.1007/s11897-023-00614-0

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