Transcript Mapping diabetes meds in i2i - The Health Federation of Philadelphia

Mapping Medications:
a foundation for clinical decision
support for diabetes
Health Federation of Philadelphia
February 29, 2016
Today’s Plan
 Why am I doing this?
 How do I do this?
 Now that I’ve mapped, how do I use it?
Why am I doing this?
 Building blocks to craft refined searches for diabetes
 Support population health management
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Outreach efforts
Provider engagement
Clinical decision support
Patient safety tool
Identification of outliers (providers)
How? Medication mapping
 First, a word about Medication categories – these are
a legacy from pre-EHR interface days. Don’t go there.
Medications
 Now, check your Medications – are there Medications
that represent useful groupings for your practice?
What you might find:
Disable the irrelevant!
Medication classes
Orals
Insulins
Other DM injectables
Thiazolidinediones
Long-acting
GLP-1 agonists
SGLT2 Inhibitors
Short-acting
Amylin agonists
Bile Acid Sequestrants
NPH/fastacting mixes
Meglitinides
…
Sulfonylureas
DPP-4 inhibitors
Alpha-glucosidase
inhibitors
Biguanides
Medication grouping rationale
 Identify potentially risky combinations
 Distinguish evidence-based practice from not (eg
metformin candidates who are not prescribed it)
 Identify patients on a given therapy combination
without improvement (who would be due for dose or
regimen change)
… I recommend mapping each class (not each
medication) separately
Medication mapping: biguanides
Medication mapping: biguanides
Finding all the right meds?
 For a comprehensive list, refer to
http://professional.diabetes.org/content/clinicalpractice-recommendations, p. S55 (Table 7.1)
Now that I’ve mapped, how do I
use it?
 Identify patients with A1c>6.5, NO metformin, and NO
creatinine >=1.5 on most recent measurement. Saved
in (Protocols), this search will populate the huddle
sheet as “Consider metformin”. For optimal provider
satisfaction, build in a metformin intolerance
(‘allergy’) filter as well.
(Protocols): consider insulin
Is this enough?
 Prescribing the right med is only the beginning… but
it can help you catch some low-hanging fruit.
 Later: need to be able to capture
 Adherence
 Barriers
 Education