Development, implementation and evaluation of an electronic medical record prompt for bone density testing.

Area of Science:

• Rheumatology
• Clinical Informatics
• Osteoporosis Management

Background:

• Long-term prednisone use significantly increases osteoporosis risk.
• Bone density testing (BMD) is crucial for monitoring at-risk patients.
• Electronic health records (EHRs) offer potential for clinical decision support.

Purpose of the Study:

• To evaluate the effectiveness of an electronic prompt in increasing BMD testing rates and bone health medication use.
• To assess rheumatology providers' perceptions of the clinical utility of an electronic prompt for osteoporosis management.

Main Methods:

• An electronic prompt was designed to alert rheumatology providers about patients aged 40+ on prednisone without recent BMD testing.
• Providers were surveyed regarding the prompt's perceived value and clinical relevance.
• Prednisone use, BMD testing rates, and bone health medication prescriptions were analyzed over time.

Main Results:

• Prednisone use remained stable throughout the study period.
• BMD testing rates were consistently low, with a slight, non-statistically significant increase over time.
• Bone health medication use also showed a modest, non-significant increase.
• Providers reported the electronic prompt was not sufficiently tailored for clinical meaningfulness.

Conclusions:

• Electronic prompts have theoretical benefits for improving osteoporosis screening and management in patients on prednisone.
• Practical implementation challenges exist, with providers finding the current prompt lacking clinical relevance.
• Further optimization of EHR-based prompts is needed to enhance their effectiveness and clinical utility in real-world settings.