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Published on: June 13, 2016
Integrating longitudinal seizure, medication, and quality of life data into epilepsy eare: A randomized crossover
Sharon Chiang1, Nicolette Miller1, Emerald Wan1
1Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Objective:
Epilepsy treatment decisions require clinicians and patients to synthesize longitudinal seizure diaries, anti-seizure medication (ASM) history, quality of life (QOL), and clinical data, which are often distributed across multiple sources. We evaluated whether an electronic health record (EHR)-integrated Epilepsy Dashboard improved patient/caregiver and clinician short-term outcomes compared with standard clinical practice.
Methods:
We conducted a prospective randomized crossover study in outpatient adult and pediatric epilepsy clinics at the University of California, San Francisco. Physicians were randomized to start with Epilepsy-BRIDGE or standard practice and crossed over after a washout interval. Epilepsy-BRIDGE is a custom Epic EHR-integrated epilepsy dashboard displaying longitudinal SeizureTracker™ diary data with overlaid ASMs, QOL scores, recent lab results/medication levels, and epilepsy history. Post-visit surveys assessed patient/caregiver measures of experience and shared review of information, and clinician-rated measures of functional suitability, efficiency, usability, and AAN epilepsy quality measures.
Results:
Thirty-nine patients/caregivers participated, including 20 Epilepsy-BRIDGE encounters and 19 standard-practice encounters. Fourteen clinicians contributed 38 post-visit surveys, including 17 Epilepsy-BRIDGE and 21 standard practice encounters. Clinicians rated Epilepsy-BRIDGE higher for efficiency, completeness, correctness, and relevance, desire for frequent use, and ease of use, and lower for complexity, inconsistency, and cumbersomeness. The majority of patient/caregiver-reported outcomes, including measures related to satisfaction, health literacy, and self-efficacy, did not differ between study arms after the study visit, with the exception of viewing medical information on the computer screen with the physician, which was more frequent during Epilepsy-BRIDGE encounters (11/15, 73.3% vs 3/12, 25.0%; p = 0.02).
Significance:
An EHR-embedded epilepsy dashboard integrating electronic seizure diaries, QOL measures, ASMs, and imaging/EEG reports improved clinician-rated efficiency and health record usability, and increased shared review of clinical information between patients and clinicians. Additional work is needed to evaluate the long-term impact on patient/caregiver outcomes of long-term exposure to integrated epilepsy dashboards.
