title: CKD as a Model for Improving Chronic Disease Care through Electronic Health Records.
abstract: Electronic health records have the potential to improve the care of patients with chronic medical conditions. CKD provides a unique opportunity to show this potential: the disease is common in the United States, there is significant room to improve CKD detection and management, CKD and its related conditions are defined primarily by objective laboratory data, CKD care requires collaboration by a diverse team of health care professionals, and improved access to CKD-related data would enable identification of a group of patients at high risk for multiple adverse outcomes. However, to realize the potential for improvement in CKD-related care, electronic health records will need to provide optimal functionality for providers and patients and interoperability across multiple health care settings. The goal of the National Kidney Disease Education Program Health Information Technology Working Group is to enable and support the widespread interoperability of data related to kidney health among health care software applications to optimize CKD detection and management. Over the course of the last 2 years, group members met to identify general strategies for using electronic health records to improve care for patients with CKD. This paper discusses these strategies and provides general goals for appropriate incorporation of CKD-related data into electronic health records and corresponding design features that may facilitate (1) optimal care of individual patients with CKD through improved access to clinical information and decision support, (2) clinical quality improvement through enhanced population management capabilities, (3) CKD surveillance to improve public health through wider availability of population-level CKD data, and (4) research to improve CKD management practices through efficiencies in study recruitment and data collection. Although these strategies may be most effectively applied in the setting of CKD, because it is primarily defined by laboratory abnormalities and therefore, an ideal computable electronic health record phenotype, they may also apply to other chronic diseases.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota;
authors.forename: Paul E
authors.initials: PE
authors.lastname: Drawz
authors.affiliation: Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland;
authors.forename: Patrick
authors.initials: P
authors.lastname: Archdeacon
authors.affiliation: Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, Maryland;
authors.forename: Clement J
authors.initials: CJ
authors.lastname: McDonald
authors.affiliation: Department of Medicine, University of California, San Francisco, California;
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.affiliation: Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, Maryland;
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Smith
authors.affiliation: National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;
authors.forename: Jenna
authors.initials: J
authors.lastname: Norton
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention, Atlanta, Georgia; and.
authors.forename: Desmond E
authors.initials: DE
authors.lastname: Williams
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.affiliation: National Kidney Disease Education Program, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;
authors.forename: Andrew
authors.initials: A
authors.lastname: Narva
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D057225:Data Mining; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000592:standards; D057286:Electronic Health Records / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D008498:Medical Record Linkage / Q000592:standards; D010348:Patient Care Team; D011369:Professional-Patient Relations; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012648:Self Care; D014481:United States / Q000453:epidemiology
keywords: CKD; clinical nephrology; kidney disease; kidney failure; nephrology