Electronic Health Record System Adopts STEADI Algorithm to Prevent Older Adult Falls

Every year, millions of older adults in the United States—age 65 and older—fall. In fact, one out of four older adults in America falls each year, but less than half tell their doctor. Falls are the leading cause of injury-related deaths among older adults, and they are the most common cause of traumatic brain injuries and hip fractures.

To respond to this serious and growing public health problem, the Centers for Disease Control and Prevention (CDC) created STEADI (Stopping Elderly Accidents, Deaths, and Injuries). STEADI helps healthcare providers screen for fall risk and reduces the risk of falling among older adults. The main components of the STEADI algorithm include three evidence-based clinical recommendations for clinicians to:

• Screen patients for fall risk. Ask if they’ve fallen in the past year, feel unsteady, or worry about falling.
• Review medicines and stop, switch, or reduce medicines that increase fall risk, and
• Recommend daily vitamin D supplements with calcium.

In 2011, Oregon Health and Science University (OHSU) partnered with the Oregon Health Authority to integrate STEADI into a clinic over a five year period to reduce falls in older adults at the community, health system, and practice levels.

Fall Prevention: A New Standard of Clinical Care

OHSU successfully implemented STEADI into their clinical practice by seamlessly incorporating the STEADI algorithm and workflow into the existing screening approach in the clinic. The clinic used a health maintenance modifier—a clinical alert that can be added to a patient’s medical chart to help healthcare providers identify and implement necessary health screenings. Because of this revised workflow, the “annual falls screening health maintenance modifier” alert was automatically applied to the medical charts of all patients age 65 and older.

The STEADI electronic health record (EHR) tool also allowed healthcare professionals to assign falls-related medical codes to each patient’s chart based on their risk of falling. This medical coding was an important key that allowed staff to collect data on falls-related quality measures. Quality measures are tools that measure the quality and outcomes of health care systems.

OHSU successfully implemented the STEADI algorithm in a large primary care setting by:

• Having clinic champions within the clinic
• Customizing the clinical workflow to work seamlessly within the normal processes
• Developing EHR tools specifically for falls screening and prevention in older adults
• Partnering with the state health department to provide a community-based resource for patients, and
• Asking for feedback, keeping partners informed, and engaging collaborators

Making an Impact

Implementation of the STEADI workflow and EHR tools at the OHSU clinic had a national impact. In December 2015, Epic—a healthcare software company—released Preventing Falls in Primary Care Using STEADI, a clinical program that provides instructions on how to incorporate STEADI into any health system using the Epic EHR system. The electronic health portal continues to be a key factor in helping healthcare providers proactively identify high-risk patients, screen them for falls, and take steps to prevent injuries. Their critical work preventing falls in older adults is now a standard of providing top-notch care.