Cleveland-based University Hospitals has built capabilities into Epic to detect an underdiagnosed form of arthritis.
The 20-plus hospital system’s IT team developed an EHR application to identify patients at risk for axial spondyloarthritis, or axSpA, a type of arthritis caused by chronic inflammation where the spine and pelvis connect.
“Everybody’s very excited,” Marina Magrey, MD, chief of rheumatology at University Hospitals, told Becker’s. “After we launched it, I have gotten requests from other physicians who would like to learn about it, how it’s done. … This is probably going to start extending into other institutions in the country.”
Epic combs for patients who are under 50 years of age and have visited a primary care provider three times within 18 months for chronic back pain not related to trauma or surgeries. The EHR then sends them a questionnaire via MyChart to assess them for symptoms related to axSpA. The questions take about two to three minutes to answer.
“We sat with the IT team to build this questionnaire within Epic … so that the patient understood why they’re getting it,” Dr. Magrey said. “Often people don’t do online questionnaires because they’re thinking it’s some kind of promotion or marketing tactic.”
Patients who answer “yes” to four or more questions can then schedule an appointment with a University Hospitals rheumatologist, who is notified about the at-risk patient via an In-Basket message.
“These patients often present with chronic back pain that starts early in life, like the second or third decade before the age of 45,” Dr. Magrey said. “There is often a long delay in diagnosis, since back pain is very common. And these folks are young, so it often gets missed.”
The average delay in diagnosis in the U.S. is about eight years, according to the Spondyloarthritis Association of America.
“The problem with this disease is that once the disease causes damage, it fuses, which is actually irreversible,” Dr. Magrey said. “So these patients then have difficulty doing activities of daily life, like bending to put on their socks or turning their neck while driving.”
So far, University Hospitals has piloted the project at about 25 primary care sites, flagging about 35,000 patients. Dozens have made follow-up appointments to see a rheumatologist.
Biopharma company UCB is sponsoring the initiative, known as FASTRAX.
Dr. Magrey envisions other uses for this type of technology in Epic. “If this is going to work in this disease, it may work in other diseases where there is often a delay to see a specialist,” she said.
