Aurora Health Care
Innovation: Screening patients for diseases using electronic medical records
Little was known about the insidious liver virus before the early 1990s, but for years it was spread through blood transfusions and organ transplants.
In 2014, Dr. Ajay Sahajpal, a transplant surgeon who oversees the Abdominal Transplant Program at Aurora St. Luke’s Medical Center in Milwaukee, saw its devastating effect on the livers of two recently-retired patients.
“They were diagnosed with cancer and I couldn’t do much about it,” he said. “They were too far gone.”
The cause of their liver cancer: Hepatitis C.
It’s a liver virus that, without treatment, can cause severe damage to the organ over many years, eventually resulting in cirrhosis, failure or cancer. Since most people who have it don’t show any symptoms — the Centers for Disease Control and Prevention estimates between 70 and 80 percent of those infected are asymptomatic — it often goes untreated until it’s too late.
Today the virus is often spread among drug users who share needles or syringes, but before widespread screening of blood transfusions and organ transplants began in 1992, it often worked its way into the veins of unsuspecting members of the baby-boom generation who were receiving medical treatment.
It is now a leading cause of liver diseases and the most common reason behind liver transplants among baby boomers.
Sahajpal, who emigrated to the U.S. from Canada, began working for Aurora in 2008 after completing a fellowship at the prestigious Mayo Clinic in Rochester, Minnesota. He wanted a way to identify the disease in patients earlier so he could treat them before it became terminal.
With his two liver cancer patients in mind, he developed an innovative screening program using the hospital network’s electronic medical records system that is now being adapted to screen other conditions and could become a model for the future as the industry shifts toward preventative care.
Since it launched in December 2014, Aurora doctors and nurses have tested around 35,000 patients for the disease, many of whom didn’t know they were
More than 600 have tested positive. They are now receiving treatment.
Aurora is adapting the screening model internally. A program based off the Hepatitis C screening protocol was launched this summer to screen patients for abdominal aortic aneurysm, a bulge on the wall of the body’s main blood vessel that, like a ticking time bomb, eventually will burst.
Within two months, it has already diagnosed several patients with the condition.
“A lot of stars aligned at once when we came up with this program,” Sahajpal said.
A few different factors were at play.
Aurora had recently installed a new medical records system — from Verona-based Epic Systems Corp. — that Sahajpal knew could be used to identify patients in the Aurora network who were at high risk for Hepatitis C. At around the same time, new medications started hitting the market that were far more effective than previous treatments, which meant diagnosing the disease early could make a substantial difference in a patient’s future. To cap it off, Aurora’s leaders had been discussing moving toward a preventative care model in the wake of the Affordable Care Act.
The idea clicked while Sahajpal was walking to a meeting with St. Luke’s vice president of operations, Bradley Kruger, and Aurora’s vice president of strategic collaboration, Laura Spurr, to discuss the transplant program. He pitched the idea to them, and they quickly set him up with a project team to develop the program.
“An idea that I floated out there off the cuff at a meeting in September of 2014 was operational in December of 2014,” he said.
Here’s how it works:
If a patient is at high risk for the disease, meaning he or she meets certain criteria set out by the CDC, then the patient’s electronic health record is flagged. The next time that patient goes in for an annual checkup or routine appointment with his or her primary care doctor, an alert will pop up on the doctor’s computer screen that the patient is at high risk for the disease. The doctor will then recommend the patient get screened.
If the patient tests positive and is asymptomatic, he or she will be hooked up with specialists to treat the virus and get a liver evaluation. If the damage caused by the disease is severe, the patient may start looking into transplant or cancer treatment options.
“Given the changes this country is facing with health care, where we have to have a shift toward population health and preventative medicine, this stuff is the kind of thing that will help,” Sahajpal said. “The more patients (for whom) we can prevent the disease process from progressing or getting to the point where they need complex health care, the better it is for everyone. This is the wave of the future.”
Aurora has begun implementing its Hepatitis C screening protocol at its partner community organizations around the city, including 16th Street Community Health Centers, the Aids Resource Center of Wisconsin, The Milwaukee Health Department and Walker’s Point Community Clinic.
Sahajpal spoke about the model at the American Medical Group Association’s Institute for Quality Leadership conference in 2015.