Harnessing the electronic health record to identify and enroll people with epilepsy into a self-management program: Implementation and scalability in a clinical setting

Rationale

“Self-management for people with epilepsy and a history of negative health events” (SMART) is an 8-week, remotely delivered, Epilepsy Self-Management (ESM) program. The ongoing EXPANDing self-management support in healthcare networks (EXPAND) initiative leveraged the Electronic Health Record (EHR) to identify SMART candidates, simplify recruitment, and reduce staff workload.

Methods

This is an ongoing implementation effort at two Level 4 Epilepsy Centers (Iowa and Cincinnati) using the Epic EHR which follows 9326 People With Epilepsy (PWE). The EHR uses pre-visit screening to identify PWE with a recent seizure; barriers to medication adherence; depression symptoms; age 18–25; or residence in rural regions. At outpatient visits, Epic generated a Best Practice Advisory (BPA). The clinician clicked the BPA to forward a referral or to signal either the patient declined or was not a candidate. The program aims to enroll 560 PWE.

Results

11 Nurse and Peer Educators received training. Within the first 5 months of BPA activation over 5000 clinician alerts were sent, 360 PWE were referred to SMART. Among 42 PWE who attended at least 1 SMART session, mean age was 35.0 (12.0), 57.5 % (N = 23) women. Mean past 30-day seizure count was 4.3 (10.0).

Conclusions

The EXPAND initiative, conducted in 2 Midwest U.S. epilepsy centers, is being successfully implemented to provide ESM to PWE. A widely available EHR has facilitated the referral process and remote delivery format allows for reach among diverse communities. This practical approach is amenable to scale-up and may be a model for expanding ESM access to PWE.