Epilepsy clinic analytics: leveraging EMR reporting tools to characterize center volume and complexity

Epilepsy centers connect patients to multidisciplinary provider groups that can coordinate surgical interventions and/or investigational treatments. Automated techniques to cross-sectionally review patient volume and complexity may reveal objective metrics to assign appropriate personnel and resources. Here, we leveraged an electronic medical record (EMR) reporting tool to examine how patient and visit volumes, antiseizure medication (ASM) prescriptions and neuromodulation use evolved over an 11-year epoch at a single level 4 adult epilepsy center in Texas, USA.

Using Epic Workbench Reporting, we acquired the dates of (i) all clinic visits (office or telemedicine), (ii) CPT codes for neuromodulation interrogation/programming, and (iii) prescriptions for all antiseizure or rescue medications from 14 epilepsy providers between 2013 and 2023. We calculated an annual complexity score (CS) for each patient, incorporating visit frequency and the total number of distinct ASMs prescribed.

Over this 11-year period, the clinic cared for 5,215 unique patients, approximately 20% of whom were only seen once. Our analysis revealed a gradual doubling of total patients served annually, an increase in ASM polytherapy rates and subtle shifts in overall ASM prescribing patterns. High CS were observed in patients treated with neuromodulation and/or administered liquid ASMs. Average annual CS gradually increased over the study period, and many patients displayed wide CS fluctuations over time.

Our results validate a simple approach to longitudinally monitor the volume and approximate complexity of patients within an epilepsy center's ambulatory clinic, providing opportunities to equitably assign personnel and resources, identify candidates for epilepsy surgery and/or remote patient monitoring strategies.