An Electronic Health Record–Integrated Application for Standardizing Care and Monitoring Patients With Autosomal Dominant Polycystic Kidney Disease Enrolled in a Tolvaptan Clinic: Design and Implementation Study
Maroun Chedid, Fouad T Chebib, Erin Dahlen, Theodore Mueller, Theresa Schnell, Melissa Gay, Musab Hommos, Sundararaman Swaminathan, Arvind Garg, Michael Mao, Brigid Amberg, Kirk Balderes, Karen F Johnson, Alyssa Bishop, Jackqueline Kay Vaughn, Marie Hogan, Vicente Torres, Rajeev Chaudhry, Ziad Zoghby
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引用次数: 0
Abstract
Background: Tolvaptan is the only FDA-approved drug to slow the progression of autosomal dominant polycystic kidney disease (ADPKD) but requires strict clinical monitoring due to potential serious adverse events. Objective: We share our experience in developing and implementing an electronic health record (EHR) based application to monitor patients with ADPKD initiated on Tolvaptan. Methods: The application was developed in collaboration with clinical informatics based on our clinical protocol with frequent laboratory test monitoring to detect early drug-related toxicity. The application streamlines clinical workflow and enables our nursing team to take appropriate actions in real-time to prevent drug-related serious adverse events. We retrospectively analyzed the characteristics of enrolled patients. Results: As of September 2022, 214 patients were enrolled in the Tolvaptan program across all Mayo Clinic sites. Of these, 126 were enrolled in the “Tolvaptan monitoring application” and 88 in the “Past Tolvaptan patients’ application”. The mean age at enrollment was 43.1±9.9 years. A total of 20 (9.3%) developed liver toxicity but only 5 (2.3%) had to discontinue the drug. The two EHR-based applications allow consolidation of all necessary patient information and real-time data management at the individual or population level. This approach facilitates efficient staff workflow, monitoring of drug-related adverse events, and timely prescription renewal. Conclusions: Our study highlights the feasibility of integrating digital applications into the EHR workflow, to facilitate efficient and safe care delivery for patients enrolled in a Tolvaptan program. This workflow needs further validation but could be extended to other healthcare systems managing chronic disease requiring drug monitoring.
期刊介绍:
JMIR Medical Informatics (JMI, ISSN 2291-9694) is a top-rated, tier A journal which focuses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation. It has a focus on applied, translational research, with a broad readership including clinicians, CIOs, engineers, industry and health informatics professionals.
Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2016: 5.175), JMIR Med Inform has a slightly different scope (emphasizing more on applications for clinicians and health professionals rather than consumers/citizens, which is the focus of JMIR), publishes even faster, and also allows papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.