One of the more challenging diseases a pulmonology practice sees with chronic disease is idiopathic pulmonary fibrosis (IPF). Patients are never seen and gone. In one form or another they come back for years to have their lung function and their medications monitored for years, and to have their side effects managed and documented over time! For practices with patients receiving a treatment in IPF, the content of that documentation may be as crucial as the treatment itself, making the need for a well-designed Electronic Health Record (EHR) system to play a critical role in chronic pulmonary care.
Why IPF Care Depends on Consistent, Long-Term Documentation
There is no cure for IPF, but using antifibrotic therapies such as Pirfenidone and Nintedanib can slow disease progression when managed carefully over time. Both have to be monitored regularly, have periodic lung function tests, liver enzyme tests, and close scrutiny of side effects which may influence the use of the medication. An unintentionally recorded missing data point, an old lab result or a side effect could directly impact the way a provider manages their patients’ care.
Practices also have to organize, maintain, and reference the information regarding IPF patients over the course of months and years of care without getting lost in a mountain of paper charts or separate lab reports.
Tracking Lung Function Trends Over Time
Tracking forced vital capacity (FVC) patterns over time is one of the crucial components of managing antifibrotic therapy, and helps providers determine if a therapy is performing as intended with respect to slowing disease progression. Chronic disease management occurs over time and an EHR designed for this will enable a provider to enter results from a FVC at each visit, instead of just a number, removing the chance of confusing it with random variation and catching it early enough to modify the care plan.
This type of longitudinal perspective isn’t easy to maintain on paper charts, because it can often be a physical effort to retrieve past records in order to compare to current information.
Observe Responses to Medication And Side Effects
The side effects of both of the main IPF therapies have to be monitored closely. Common side effects of pirfenidone include sensitivity to the skin or changes in liver enzymes, but diarrhea is the most common side effect of nintedanib. Well-designed EHR templates are used to record these side effects in a uniform way on every visit, and the provider can code these with the appropriate diagnosis until symptoms return or are resolved as time goes on to document and track changes as a result of adjusting treatment.
This systematic process also contributes to the improved communication of the care team. If a patient calls with a new symptom, staff can simply review the symptom changes already recorded on the patient’s history chart without having to make a new report to the doctor. When a patient reports a new symptom to staff, they can get an idea of the other adjustments the patient has recorded and the documented side effects on the symptom history chart, rather than creating a new report to the doctor.
Helping Make Informed Treatment Decisions
The selection of therapy depends very much on a patient’s full history, including previous side effects, laboratory trends and response to therapy to date, and may be combined, or varying therapy options may be considered. When a provider has to make a judgment for covering and coordinating care across access points, an EHR’s ability to bring all of this information together is more beneficial for them than relying on their memory or a variety of loose notes from past visits.
This is particularly useful as more IPF patients come on lifelong antifibrotic therapy, and more beneficial as the practice scales.
Minimizing Administrative Exoneration Of Chronic Care Management
However, EHR systems are also beneficial for their clinical use, as well as decreasing the administrative paperwork that is generated by chronic pulmonary patients. For the monitoring to keep on schedule, there are automated reminders for upcoming lab work or lung function testing. Documented structures reduce the amount of time staff have to look for previous documentation during follow-up calls. If a patient’s needs must change hands within the practice(s), charts that are organized and clear will help to ease the transition for a new provider.
What Practices Should Look for in an EHR
Managed chronic disease practices that use EHRs should ensure it allows for tracking lung function and lab measurements over time, includes customizable templates for various treatment modalities, includes treatment-schedule driven prompts to encourage related treatment activities and has easy-to-understand reporting options that enable quick reference to a patient’s total treatment history.
Conclusion
Treating progressive IPF takes more time and more than just treating the disease with the correct drugs. It involves a good, and meticulous, record of patient response to therapy over months and years. With the right EHR system, pulmonology practices can have the organization necessary to keep track of medications and treatments in use, such as Pirfenidone and Nintedanib, making informed choices and providing the attentive, consistent care that chronic conditions require.
