Kaiser Permanente Study: Safety Alerts in Electronic Medical Records Reduces Rates of Potentially Dangerous Medication Interactions

Kaiser Permanente Study Shows Co-prescription of Warfarin and Other Drugs Drops 15 Percent


Portland, OR –Creating safety alerts that appear in electronic medical records (EMRs) when clinicians co-prescribe medications with potentially dangerous interactions reduces the number of co-prescriptions by nearly 15 percent.


The results of the Safety in Prescribing study, conducted by Kaiser Permanente’s Center for Health Research, appear in the May 8th issue of the Archives of Internal Medicine. “This study shows that safety alerts in electronic medical records are a powerful tool to help clinicians make decisions about what drugs they should prescribe for their patients,” says Adrianne Feldstein, MD, MS, lead author of the study and an investigator at Kaiser Permanente’s Center for Health Research. “We compared the effects of two interventions in outpatient clinical settings – safety alerts in EMRs versus safety alerts plus clinician education courses. We found that adding clinician education to EMR safety alerts did not reduce the rates of co-prescribing medications that interact any more than EMR safety alerts alone. The reason is unclear, but it may be that the “just in time” information provided by safety alerts is more useful to clinicians than education courses.” The study focused on patients who were prescribed warfarin, which is an anticoagulant that prevents blood clots from forming or growing larger.


Warfarin is prescribed to patients with blood clots in the lower extremities; patients with atrial fibrillation, artificial heart valves, and coronary artery stents; and patients who have knee or hip replacements. It was chosen for the study because it is widely used – over one million prescriptions annually – and because so many drugs – prescription and non-prescription – interact with warfarin to increase its blood-thinning effects.


Results of a report from a large pharmacy benefits manager database show that more than two-thirds of patients receiving warfarin during a one-year period received at least one interacting medication that increased bleeding risk. To conduct the study, the researchers tracked the co-prescribing rates of clinicians at 15 primary care clinics before the alerts from January 2000 through November 2002. They analyzed the electronic medical records of 9910 patients taking warfarin to find out the prescription rates of warfarin and five interacting medications - acetaminophen, non-steroidal anti-inflammatory medications, fluconazole, metronidazole, and sulfamethoxasole.


During a four-month period from December 2002 to March 2003, safety alerts were randomly implemented in eight clinics, and safety alerts and education courses were implemented in the other seven clinics. The safety alerts remained active in all 15 clinics for 18 months from April 2003 through August 2004. In the 12 months prior to the alerts, warfarin patients received 3,288 interacting prescriptions for every 10,000 warfarin patients.


Interacting prescriptions for warfarin patients decreased immediately after the alerts were implemented, with an estimated drop in the first month of 329.7 interacting prescriptions for every 10,000 warfarin patients. Twelve months after the alerts were implemented, warfarin patients received 2804.2 interacting prescriptions for every 10,000 warfarin users.


Compared to an co-prescription without safety alerts estimated at 3294.0, the alerts led to an estimated reduction of 489.8 interacting prescriptions for every 10,000 warfarin patients, a 14.9% relative reduction. The effect was predominantly due to reductions in the co-prescribing of warfarin and acetaminophen. “Clinicians face difficult choices when ordering prescription drugs for warfarin patients,” Dr. Feldstein says. “Because so many drugs interact with warfarin and have the potential for harm, ideal choices are seldom available.


For example, if a warfarin patient is having a lot of pain, should the clinician prescribe acetaminophen – which can cause excessive bleeding – or should the clinician prescribe codeine – which can cause drowsiness and could lead to an older patient tripping or falling and breaking a hip? There is not always an easy answer.


What safety alerts do is help clinicians make these difficult decisions by alerting them about the known interactions among the medications they’ve entered into the electronic medical record and by indicating alternative medications they might prescribe.” This study was funded through cooperative agreement U18 HS11843 for the Agency for healthcare Research and Quality (AHRQ).


This study is one of a series of studies being conducted by researchers at ten HMOs throughout the United States as part of AHRQ’s Centers for Education and Research on Therapeutics and Patient Safety research programs.


Kaiser Permanente’s Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health. Kaiser Permanente is the nation’s leading integrated health care organization. Founded in 1945, it serves more than 8.4 million people nationwide, including more than 485,000 in Oregon and Southwest Washington.

Aetna Advantus

Aetna Introduces Advantus

New business unit to expand market reach

HARTFORD, Conn., May 9, 2006 —

Aetna announced today the launch of a new business unit — AdvantusSM — to provide products and services to insurance companies, third party administrators, regional health plans and other customers.


Advantus will offer provider networks, such as those acquired in Michigan and Colorado last year, selected medical management services, and health care specialty services to customers outside Aetna’s core distribution channels. "By establishing Advantus, we will have another independent and recognizable brand to sell high-quality, stand-alone products and services to other insurance companies and health plans," said Mark Bertolini, executive vice president and head of Aetna Regional Businesses. "The new business unit is part of Aetna’s strategy to expand aggressively into new customer segments."


Companies acquired over the past two years by Aetna, such as HMS HealthCare, HMS Health Management, PPOM, Sloans Lake, Mountain Medical Affiliates, Flora and ProNet will become part of Advantus. Those operations currently generate more than $100 million in revenue, have more than 400 employees and serve 1.8 million members.


In addition, new products being offered initially by Advantus include Out-of-Network Claims Management, Dental Network Access, Stop Loss, Credentialing, selected Medical Management programs, and Behavioral Health Employee Assistance Programs and Disease Management. Other products and services are in development. Advantus will be organized into several units: Advantus Networks, offering provider network access; Advantus Health Management, offering health management services; and, Advantus Health Plan Services, offering health care-related specialty services.


"We are excited to be launching Advantus," said Dan Fishbein, M.D., who will head the new business unit. "Advantus brings a number of our current product offerings under one name and provides excitement and a new focus that we will leverage to strengthen our market position. This business unit will provide Aetna with new opportunities for growth by pursuing new markets for both existing and acquired capabilities."


Initially Advantus will have operations in Michigan, Colorado, Texas, Connecticut and Maine. The Advantus brand roll-out will be phased in over an 18-month period, with some operations changing names immediately, while others will follow over time. Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 28.3 million people with information and resources to help them make better informed decisions about their health care.


Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life, long-term care and disability plans, and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans and government-sponsored plans.

BCBS of Wisconsin is Now Doing Business as Anthem Blue Cross and Blue Shield

New brand means added benefits and services for Wisconsin members

Milwaukee, WI (April 25, 2006) – Starting May 1, Blue Cross Blue Shield of Wisconsin (BCBSWi) and its HMO subsidiary, Compcare Health Services Insurance Corporation, will do business as Anthem Blue Cross and Blue Shield, taking on a trusted brand name that symbolizes quality for millions of consumers across the country.

The new name will provide a recognizable brand identity for distinct new programs, services and networks for existing and new customers. The Anthem Blue Cross and Blue Shield brand, used by 11 health plans across the country, is a well-recognized health benefits brand known for quality, affordable health care and has a strong reputation in the market as a trusted choice for consumers.

While the name and logo will be different, members will receive the same superior customer service they are accustomed to along with more e-commerce capabilities and enhanced product offerings. “We are excited that Anthem Blue Cross and Blue Shield is our new brand name. The Anthem brand reflects what consumers, healthcare professionals and brokers are looking for in their health care insurer - affordable health benefits, access to technology, choice, superior service and the strength and trustworthiness of the Blue brand. At Anthem Blue Cross and Blue Shield, we are committed to transforming the healthcare industry by putting the consumer in the center of all we do,” said Stuart K. Campbell, president of Anthem Blue Cross and Blue Shield in Wisconsin. Anthem Blue Cross and Blue Shield will introduce new products and services that will bring Wisconsin consumers more health insurance options and added-value services, and offer one-stop shopping features for consumers who purchase multiple plans including life and dental products.

In addition, agents, brokers, employers and consumers will be able to take advantage of new online services and information that will make it easier to do business with Anthem and ultimately feel better about themselves and their health. “As Anthem, we will be able to tap into extensive national capabilities that benefit Wisconsin consumers while maintaining our local decision making,” Campbell said. “Over the next few months, consumers will begin to see the new Anthem Blue Cross and Blue Shield name in the marketplace as new products are introduced, but our members in Wisconsin will continue to have access to our great services and provider networks.”

About Anthem Blue Cross and Blue Shield...Anthem Blue Cross and Blue Shield is the trade name used by Blue Cross Blue Shield of Wisconsin ("BCBSWi") and Compcare Health Services Insurance Corporation ("Compcare"), independent licensees of the Blue Cross and Blue Shield Association. In Wisconsin, Anthem Blue Cross Blue Shield is one of the largest health insurers. BCBSWi and Compcare are subsidiaries of WellPoint, Inc.

WellPoint, Inc. is an independent licensee of the Blue Cross Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare.