STANFORD, CA – A clinical guidelines system that helps physicians treat patients with chronic hypertension is drawing positive reviews from users and helping them better manage their patients.

A recently published study finds that the Athena system, designed by physicians and medical informaticists at Stanford Medical Center and the VA Palo Alto Health Care System, is being used frequently and that physicians find it helpful in managing patients. Because of the encouraging results, developers may adapt the system for use with other chronic diseases.

Athena is a decision support system that was developed several years ago, said Mary Goldstein, MD, associate professor of medicine at VA Palo Alto, a faculty member at Stanford University's Center for Primary Care and Outcomes Research and lead investigator for the Athena project.

The system first culled electronic records to provide care suggestions on paper to physicians. "We were encouraged by what we saw there and there was improvement in guideline-recommended treatment," she said.

Developers then designed an elaborate computer system to generate recommendations on hypertension. Athena takes information from patients' medical recordsand a separate knowledge base of hypertension guidelines. It then produces recommendations that are specific to each patient.

Athena next presents the recommendations inside a patient's electronic medical record, so when a physician opens the electronic record of a hypertensive patient, the guidance pops open in a separate window.

"For something that's a common chronic problem, I thought it was important to make the system exquisitely easy," Goldstein said. "We didn't want to get in their way, so we made it very easy to see and also very easy to ignore."

For the study, Athena was provided to 91 physicians and other clinicians at nine VA clinics in northern California and Durham, N.C. Over 15 months, clinicians interacted with Athena for 63 percent of eligible patients, results showed.Based on data entered into the system, Athena might recommend increasing the dose of a medication, prescribing a new medication or ordering a lab test. It also provided information on counseling patients about diet and exercise. It shows whether patients had filled medication orders and provides graphs that can show blood pressure over time, which can indicate the effectiveness of drug therapies.

"It doesn't just tell you, ‘Your patient's blood pressure is out of control.' It says, ‘Here's what you can do about it,' and it shows you the supporting evidence," said Eugene Oddone, MD, director of the Center for Health Services Research at the Durham VA Medical Center.

Goldstein said the Athena system might be adapted to provide clinical guidance for treating patients who have diabetes or high cholesterol.While the system now works with the VistA system used by the VA health system, it could be adapted for use with other computer systems, and results have sparked interest from other healthcare organizations, Goldstein said.