Learning needs related to osteoporosis care and barriers to guideline implementation using EMR tools that were identified with open-ended questions
| OPEN-ENDED QUESTION | EXAMPLE QUOTATIONS |
|---|---|
| What do you have a great deal of difficulty with regarding osteoporosis diagnosis and screening? | |
| Learning needs related to diagnosis and screening | |
| • Interpreting BMD reports, particularly for patients receiving treatment | “Radiologists have started saying, ‘Cannot provide risk because patient is on therapy for osteoporosis.’ So, what do I do with this report?” |
| • When to order a BMD test | “I am currently not ordering BMD on a male patient over 65 years without any risk factors, as I don’t know what to do with the results if they have osteoporosis” |
| • When to repeat BMD tests | “Never quite sure when and how often to order repeat BMDs, especially for low-risk patients or those on bisphosphonates!” |
| Learning needs related to treatment | |
| • Managing patients who are in the moderate-risk category | “The high-risk and low-risk patients are easy … it’s those darn moderate-risk patients and trying to determine who require[s] treatment” |
| • Prescribing pharmacotherapy for osteoporosis | |
| -Types of treatment and first-line therapies | “Unbelievably confusing about who to treat with what and for how long!” |
| -Duration of treatments and drug holidays | “Duration of bisphosphonate therapy appears to be the Wild, Wild West of osteoporosis treatment … no one seems to know the optimal duration of bisphosphonate therapy” |
| What do you feel are barriers to implementing guidelines using EMR tools? | |
| Too time consuming to learn how to use the tools | “The biggest barrier is the first use. If someone showed me how to use my EMR to assess risk and evaluate if BMD is necessary, I think it would become part of my routine” |
| Difficulty introducing new tools into EMR software | “PS [Suite EMR] software is problematic with the introduction of new stamps and templates” |
| Difficulty revising the tool when guidelines are revised and software is updated | “EMR tools are great … but how do we keep these up to date as the guidelines change?” |
BMD—bone mineral density, EMR—electronic medical record.