Spotlight: From Clicks to Clinical Impact – Making the EHR Work for Safer Anticoagulation Ordering

Spotlight Overview:Electronic health records have the potential to improve patient safety—but only when they are intentionally designed to support clinical decision-making. In this CardiQ Spotlight, Megan Lere, APRN, and Mitchell Steltzer, DO, share how their organization redesigned anticoagulation ordering within the EHR to reduce prescribing errors, standardize care, and improve patient safety across multiple care settings. By integrating clinical decision support, collaborating with information technology and multidisciplinary teams, and measuring adoption over time, they demonstrate how thoughtful EHR optimization can drive meaningful quality improvement and improve anticoagulation management.

Why This Matters:Clinical decision support tools can reduce variation, improve prescribing accuracy, and make it easier for clinicians to deliver evidence-based care. This Spotlight illustrates how optimizing the EHR through multidisciplinary collaboration can strengthen patient safety, improve workflow efficiency, and support more consistent anticoagulation management across the health system.

CardiQ Framework: This Spotlight demonstrates the following CardiQ Framework pillars:

	Prepare: Identify anticoagulation prescribing errors, evaluate existing workflows, and define opportunities to improve patient safety through EHR optimization.
	Engage: Collaborate with physicians, APPs, pharmacists, IT specialists, medication safety teams, and clinical leaders to build consensus around the new order set.
	Design: Develop a standardized EHR order panel with built-in clinical decision support, dosing guidance, refill management, and risk assessment tools.
	Implement: Integrate the order set into the EHR, educate clinicians, and deploy the tool across the health system to support safer prescribing practices.
	Report: Monitor utilization of the order set, compare prescribing patterns before and after implementation, and evaluate improvements in anticoagulation management.
	Sustain/Scale: Continue measuring adoption, gather feedback from clinicians, and refine the tool to support long-term improvements in patient safety and clinical practice.

1. Identifying the Safety Gap

The project began by recognizing a recurring problem: inconsistent anticoagulation prescribing and incorrect medication dosing across emergency departments and freestanding facilities. Learn how identifying these care gaps inspired the development of a safer, more standardized prescribing process. Estimated viewing time: xx minutes.

2. Designing Clinical Decision Support

Rather than relying on memory alone, the team redesigned the anticoagulation order process within the EHR. Discover how clinical decision support, standardized order panels, dosing guidance, refill management, and integrated risk assessment tools help clinicians prescribe the right therapy more consistently. Estimated viewing time: xx minutes.

3. Implenenting Change

Successful implementation requires more than a well-designed order set. Hear how engaging medication safety teams, physicians, APPs, nurses, pharmacists, and IT stakeholders early in the process helped build consensus, strengthen organizational support, and accelerate implementation. Estimated viewing time: xx minutes.

4. Measuring Impact and Expanding Success

Quality improvement extends beyond implementation. Learn how the team plans to evaluate adoption of the new order set, compare prescribing patterns before and after implementation, and measure improvements in patient safety. Hear how standardized clinical decision support also improved prescribing beyond atrial fibrillation, demonstrating the broader impact of thoughtful EHR optimization. Estimated viewing time: xx minutes.

5. Lessons for Future Improvement

Even small workflow changes can have system-wide impact. Hear how standardized clinical decision support not only improved anticoagulation prescribing for atrial fibrillation but also benefited other clinical indications, reinforcing the value of designing quality improvement initiatives that can scale across an organization. Estimated viewing time: xx minutes.

Putting it Into Practice

• Use clinical data to identify patient safety gaps before designing an EHR solution.
• Build clinical decision support into existing workflows to reduce variation and support evidence-based prescribing.
• Engage multidisciplinary stakeholders early to build consensus and accelerate implementation.
• Measure adoption and prescribing patterns to demonstrate impact and guide continuous improvement.
• Look for opportunities to extend successful tools beyond their original clinical use to maximize organizational value.