title: An Electronic Medical Record Report Improves Identification of Hospitalized Patients With Heart Failure.
abstract: BACKGROUND
  Early identification of inpatients with heart failure (HF) may help to reduce readmissions. We found that many patients identified by our coding team as having a primary diagnosis of HF were not identified by our clinical team. We hypothesized that an electronic medical record (EMR)-based report would improve identification of hospitalized patients eventually diagnosed with HF.
  
  
  RESULTS
  We constructed an automated EMR-based tool to allow our team to identify patients with HF more quickly and accurately. We selected criteria that could potentially identify the cohort as patients with an exacerbation of HF. We performed monthly reconciliations, comparing the list of patients identified by our coding team as having a primary diagnosis of HF versus the patients identified by our team as having HF. We reduced a baseline 17% discrepancy of patients coded as HF but not identified by our team to 9.5% in the year after implementation of our screening tool (P = .006), and to 5.4% in the next year (P = .03); 56% of patients that were identified as having HF by our CNS team were coded as having HF, versus 49% in the 2 years after implementation (P = .15). Thirty-day readmission rates to our hospital decreased from 16% to 11% (P = .029).
  
  
  CONCLUSIONS
  An EMR-based approach significantly improved identification of patients discharged with a primary diagnosis of HF. Future investigations should determine whether early identification of inpatients with HF can independently lower readmissions, and whether this strategy can successfully identify outpatients with HF.
authors.affiliation: Stanford Health Care, Stanford, California. Electronic address: dipanjan@stanford.edu.
authors.forename: Dipanjan
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Stanford Health Care, Stanford, California.
authors.forename: Christine
authors.initials: C
authors.lastname: Thompson
authors.affiliation: Stanford Health Care, Stanford, California.
authors.forename: Angela
authors.initials: A
authors.lastname: Bingham
authors.affiliation: Stanford Health Care, Stanford, California.
authors.forename: Charlene
authors.initials: C
authors.lastname: Kell
authors.affiliation: Stanford Health Care, Stanford, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Duhon
authors.affiliation: Stanford Health Care, Stanford, California.
authors.forename: Helene
authors.initials: H
authors.lastname: Grossman
mesh_terms: D057286:Electronic Health Records; D006333:Heart Failure / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D010355:Patient Identification Systems; D010359:Patient Readmission
keywords: Electronic medical record; cohort identification; heart failure