title: Features of electronic health records necessary for the delivery of optimized anticoagulant therapy: consensus of the EHR Task Force of the New York State Anticoagulation Coalition.
abstract: BACKGROUND
  Oral anticoagulants are prescribed to millions of Americans, and consequently are among the medications most likely to contribute to emergency department visits and hospitalizations. Although guidelines and consensus statements promote systematic approaches to therapy, anticoagulation (AC) management is often suboptimal. Electronic health records (EHRs) have the potential to improve safety and quality but have not yet incorporated specialized features necessary to optimize therapy.
  
  
  OBJECTIVE
  To generate a comprehensive, consensus-based list of EHR features clinically necessary to deliver optimized AC management, provide a "language bridge" to accelerate incorporation of features into EHR systems, and suggest mechanisms for the objective evaluation of available EHRs.
  
  
  METHODS
  A multidisciplinary panel of AC specialists utilized the framework of a previously published consensus statement to map outpatient AC management and developed a comprehensive array of sequential computer logic steps using a restricted language scheme. Logic steps were then translated into narrative descriptions of potential EHR features, which were refined through multiple group evaluations. A finalized list of proposed features was ranked according to perceived clinical necessity by physician, pharmacist, and nurse panelists in a blinded manner using a 5-point Likert scale. Features receiving no more than 1 dissenting opinion were included in a finalized list of clinically necessary features.
  
  
  RESULTS
  The task force generated 78 recommended EHR features across 20 key discrete areas and 425 individual logic steps. All recommended features received Strongly Agree or Agree rankings regarding their perceived clinical necessity, and no feature received more than a single Disagree response.
  
  
  CONCLUSIONS
  The incorporation of key AC-related features into existing EHRs or specialized AC management systems has the potential to systematize the delivery of optimal AC care by health care professionals at the point of care. Optimized AC management has the potential to reduce adverse drug events associated with anticoagulant therapy in the outpatient setting.
authors.affiliation: North Shore Long Island Jewish Health System at Lenox Hill Hospital, New York, NY, USA aspyropoul@nshs.edu.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
authors.affiliation: IPRO, Albany, NY, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Viscusi
authors.affiliation: Lenox Hill Hospital, New York, NY, USA.
authors.forename: Nakul
authors.initials: N
authors.lastname: Singhal
authors.affiliation: IPRO, Lake Success, NY, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Gilleylen
authors.affiliation: Rochester General Hospital, Rochester, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kouides
authors.affiliation: Nalitt Institute for Cancer & Blood-Related Diseases, Staten Island, NY, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Howard
authors.affiliation: Bassett Medical Center, Cooperstown, NY, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Rudd
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Ansell
authors.affiliation: IPRO, Albany, NY, USA.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Triller
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D006760:Hospitalization; D006801:Humans; D054539:Medication Therapy Management; D009518:New York
chemical_list: D000925:Anticoagulants
keywords: adverse drug reactions; anticoagulants; anticoagulation; computers; drug safety; electronic information; medical informatics; medication safety; quality assurance; warfarin