Access Health Record at Push of Button When Evidence Lacking

A green-button function being tested in electronic health records lets physicians access basic information on treatments and outcomes for patients similar to the one they’re treating, say researchers at Stanford University in California.

The data being aggregated by the team will inform physicians at the point of care in the event that evidence from randomized trials is not available, said Christopher Longhurst, MD, from Stanford Children’s Health, who is leading the green-button team.

The idea is to use practice-based evidence generated from clinical processes.

“There are always going to be situations where it doesn’t make sense to randomize because populations are so small or the time required to see the end point would be too long,” Dr Longhurst explained at the Big Data in Biomedicine Conference held at Stanford University.

The idea for the green button was generated after a 13-year-old girl nearing kidney failure was helicoptered to Lucile Packard Children’s Hospital Stanford. After Jennifer Frankovich, MD, and her team, which included Dr Longhurst, diagnosed lupus, they debated whether the patient should be treated with anticoagulant therapy. Because lupus is not common in children, no evidence from randomized trials was available.

“In the adult world, you anticoagulate everybody who’s not actively bleeding,” Dr Longhurst said. “But in the pediatric world, the risk–benefit ratio is different.”

Dr Frankovich did something that had never been done before. She used electronic health records to identify a cohort of 98 similar patients who had been treated at Stanford over the previous 5 years.

Leveraging Data

“Using some data in the text notes, she was able to identify an odds ratio of 7- to 15-fold greater relative risk of clotting for children like this one. Based on that, we made the decision to anticoagulate,” said Dr Longhurst. A report on the experience was published the New England Journal of Medicine(2011;365:1758-1759).

We will never know if that was the right decision, but the girl didn’t clot and didn’t have adverse effects from the anticoagulant, Dr Longhurst said.

“If my daughter were hospitalized, I’d want her to get the most data-driven decisions, rather than what we do today,” he said.

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