Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: A major impediment to use of patient questionnaires in routine clinical care has been the absence of electronic entry for patients and for doctors to introduce data into electronic medical records (EMR), particularly as most EMRs are incompatible with each other. RAPID3 (routine assessment of patient index data) on a multi-dimensional health assessment questionnaire (MDHAQ) has been found as useful in rheumatoid arthritis (RA) clinical trials as indices which require a formal joint count, such as disease activity score 28 (DAS28) or clinical disease activity index (CDAI), to distinguish active from control treatments, and to monitor clinical care. RAPID3 also is informative to recognize improvement in patients with osteoarthritis, systemic lupus erythematosus, spondyloarthropathies, vasculitis, and gout. Therefore, a number of organizations have developed electronic versions of RAPID3, often for demonstration projects and to provide quality indicators in routine clinical care. Most electronic versions mimic EMRs in being incompatible with one another, and therefore not easily merged with one another to study patient courses and outcomes, and invovling considerable expense. A common electronic version of MDHAQ used by many rheumatologists can be merged easily for collaborative research, and rendered compatible with any EMR through mandated HL7 and SMART on FHIR interfaces. We sought to develop an electronic MDHAQ/RAPID3 to be compatible with any EMR, although requiring initial collaboration with the EMR vendor, for routine clinical care.
Methods: A developer was identified with expertise in HL7 and SMART on FHIR interfaces and cloud-based storage, meeting all government privacy and security requirements. The developer has worked closely with rheumatologists to develop a user-friendly electronic MDHAQ, including RAPID3 and many additional scales (Table).
Results: The electronic MDHAQ functions quite effectively, providing RAPID3 and much additional information beyond RAPID3 (Table). For example, among 287 patients with RA in one clinical setting, secondary fibromyalgia (FM) was diagnosed in the EMR by rheumatologists in 10 patients (3.5%), while scores on a MDHAQ-FM index composed of pain, RADAI self-report joint count, and symptom checklist, indicated secondary FM in 61 patients (21.2%), of whom only 6 were identified by rheumatologist. An interface with an EMR through HL7 and SMART on FHIR is available, although requiring collaborative interactions to establish the interface.
Conclusion: An electronic MDHAQ offers considerably more information then only an electronic RAPID3, with no extra work on the part of the physician, while saving time with far better documentation, particularly with establishment of an interface to the EMR through HL HL7 and SMART on FHIR. Rheumatologists and organizations are encouraged to implement an electronic MDHAQ/RAPID3, rather than simply an electronic RAPID3.
Features of electronic MDHAQ/RAPID3 for routine rheumatology care
|RAPID3||Informative in RA, OA, AS, vasculitis, SLE, gout|
|Fatigue||Higher in SLE, FM than RA|
|Psychological variables: sleep, anxiety, depression||Screen for frequent source of patient problems|
|RADAI Self-report joint count||Correlated r>0.04-0.06 with TJC, SJC, in range of ESR vs CRP|
|Symptom checklist||Most effective screening tool reported for FM –|
|Recent medical history||Updates recent illness, surgery, adverse events, etc. for clinician|
|Calculations||Calculates RAPID3, RADAI, # symptoms, psych HAQ; MDHAQ FM index of pain>6, RADAI>16, symptoms>16/60; also DAS28, CDAI, if joint count and lab test available|
To cite this abstract in AMA style:Pincus T, Cook N. An Electronic MDHAQ (multidimensional health assessment questionnaire) Beyond an Electronic RAPID (routine assessment of patient index data): 21.3% of Rheumatoid Arthritis Patients Identified As Having Secondary Fibromyalgia Versus 3.5% By Clinicians [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/an-electronic-mdhaq-multidimensional-health-assessment-questionnaire-beyond-an-electronic-rapid-routine-assessment-of-patient-index-data-21-3-of-rheumatoid-arthritis-patients-identified-as-having/. Accessed November 30, 2020.
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