JMIR Publications

ABSTRACT

Background:

Hydroxychloroquine (HCQ) is commonly used for patients with autoimmune conditions. Long term use of HCQ can cause retinal toxicity, but this risk can be reduced if high doses are avoided. We developed and piloted an EHR-based dashboard to improve safe prescribing of HCQ within the Veterans Health Administration (VHA).

Objective:

To analyze the impact of a new patient safety dashboard deployed within the VHA to improve the safe prescribing of HCQ.

Methods:

Patients receiving HCQ were identified from the VHA Corporate Data Warehouse. Using PowerBI (Microsoft), we constructed a dashboard to display patient identifiers and most recent HCQ dose and weight (flagged if ≥ 5.2mg/kg/day). Six VHA pilot facilities were enlisted to test the dashboard and invited to participate in monthly webinars. We performed an interrupted time-series analysis using synthetic controls to assess changes in the proportion of patients receiving HCQ ≥ 5.2mg/kg/day between August 2020 to December 2021.

Results:

We identified 18,190 total users of HCQ nationwide in the VHA, including 1,276 patients at the 6 pilot facilities. Nationwide at baseline, 20.6% of patients were receiving high doses of HCQ. We observed significant improvements in the proportion of HCQ prescribed at ≥ 5.2mg/kg/day among pilot facilities, decreasing by 5.8 percentage points (pp) after intervention compared to 0.01 pp among synthetic controls. The post-intervention linear trend for pilot vs synthetic control performance was significant (-0.064, 95%CI (-0.08, -0.05)).

Conclusions:

Use of an EHR-based dashboard reduced the proportion of patients receiving higher than recommended doses of HCQ and significantly improved performance at six VHA facilities. National roll-out of the dashboard will enable further improvements in safe prescribing of HCQ. Audit and feedback using clinician-facing dashboards that provide key measures and reports directly to clinicians can improve patient safety.