Leveraging EHRs to Close Gaps in Postmenopausal Osteoporosis Care

Summary

Podcast Summary: Leveraging EHRs to Close Gaps in Postmenopausal Osteoporosis Care

Podcast: Becker’s Healthcare Podcast
Date: December 1, 2025
Host: Erica Spicer Mason (Becker’s Healthcare)
Guest Speakers: Kristen Buessman (Amgen), Dr. Barry Wendt (Chief Medical Information Officer, St. Elizabeth Healthcare)

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Episode Overview

This episode explores how health systems can leverage advanced Electronic Health Record (EHR) functionalities—specifically Diagnosis Aware Notes (DANs)—to close care gaps in postmenopausal osteoporosis management. The discussion highlights St. Elizabeth Healthcare’s strategies for utilizing EHR innovations to guide clinicians using up-to-date guidelines, improve documentation, streamline workflows, and ultimately provide better population health outcomes for a commonly under-treated patient group.

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Key Discussion Points and Insights

The Burden of Osteoporosis in Health Systems

• St. Elizabeth Healthcare Background
  • Large Midwestern health system with over 800 providers; recognized for top physician EMR satisfaction.
  • High prevalence of postmenopausal osteoporosis; many women remain undertreated even after diagnosis ([01:52]).
• Clinical Challenge
  • “Many women are undertreated and we find that even though they're diagnosed, sometimes they're just put on calcium, vitamin D and given exercise, but not really put on the adequate therapy that they need.” — Dr. Barry Wendt ([02:25])
  • Multiple new drug classes and evolving guidelines over the past decade make it hard for clinicians to keep up.
• Consequences
  • After an osteoporotic fracture, postmenopausal women are five times more likely to suffer another fracture; this risk persists lifelong ([03:18]).

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Leveraging EHR: Diagnosis Aware Notes (DANs)

• Problem-Oriented Charting in EPIC
  • Introduces a documentation workflow based on specific conditions, integrating smart text and clinical decision guidance ([04:45]).
  • DANs are “notes that follow a more natural workflow for the provider. They can document the way they did years ago with writing on paper in a natural workflow.” — Dr. Wendt ([04:52])
• Smart Text Integration
  • Automatically inserts guideline-driven recommendations and templates associated with the diagnosis.
  • Reduces documentation time and cognitive load ([05:35]).
  • “Embedded within that smart text, we're able to put guideline driven decisions that nudges providers to do the right thing.” — Dr. Wendt ([05:09])
• Comparison to BPAs (Best Practice Advisories)
  • DANs provide non-disruptive guidance, avoiding the interruptions of pop-up advisories ([06:07]).
  • “It's decision making within that smart text...not only does it greatly speed up their time documenting, but it reduces their cognitive effort.” — Dr. Wendt ([06:18])

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Impact on Osteoporosis Care

• Guideline Compliance and Workflow
  • Improved adherence to updated treatment and testing recommendations for osteoporosis.
  • “We're finding much more compliance with the guidelines than we were prior to having these in place.” — Dr. Wendt ([07:19])
• Enhanced Documentation and Patient Follow-Up
  • Automatic prompts for missing lab orders (e.g., vitamin D levels), ensuring completeness ([07:39]).
  • “If a patient hasn't had a vitamin D level checked, then the provider is immediately aware...and will place an order.” — Dr. Wendt ([07:47])

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Implementation Advice

• Setting Up DANs
  • Simple to build; easier than digesting clinical guidelines.
  • “It takes less time to read the guidelines than it does to build these inside our EHR.” — Dr. Wendt ([08:33])
  • Steps: Build the template to fit guidelines, associate with a diagnosis grouper (e.g., diabetes), and configure preferred options to default in ([08:40]–[09:16]).

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Integration Challenges and Future of EHR Technologies

• Provider Acceptance
  • Main challenge is avoiding workflow disruptions; DANs are popular for their seamless integration ([09:41]).
  • “Providers don’t like disruptions during their workflow. The great thing about these is they're non disruptive, unlike the pop up BPAs.” — Dr. Wendt ([09:45])
• AI in Healthcare
  • Caution expressed around overreliance on AI, which may not consistently enforce guidelines like curated templates do ([10:04]).
  • “The problem I see is the AI might not pick up the appropriate guidelines or might not walk you through the steps...These are truly curated steps.” — Dr. Wendt ([10:13])
• Guideline-Driven Innovation
  • Emphasis on blending new technologies with clinically-informed pathways and provider expertise ([10:49]).

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Notable Quotes & Memorable Moments

• Importance of Proper Therapy
  “Many women are undertreated...but not really put on the adequate therapy that they need.” — Dr. Barry Wendt ([02:25])
• EHRs as Partners in Care
  “Diagnosis aware notes are extremely easy to use...takes minutes really to build these out.” — Dr. Barry Wendt ([08:57])
• Balancing Technology and Clinical Wisdom
  “I’m concerned...we’re going to be too reliant on AI and AI might not provide the correct answer. So I think that’s where [diagnosis aware notes] have a significant advantage...” — Dr. Barry Wendt ([10:16])

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Timestamps for Key Segments

| Timestamp | Segment Description | |------------|--------------------------------------------------------------------------------------------------| | 01:52–04:06| Dr. Wendt outlines St. Elizabeth’s scope and the challenges/impact of osteoporosis | | 04:39–06:40| Dr. Wendt introduces Diagnosis Aware Notes and their practical advantages in EHR documentation | | 07:04–07:24| Specific improvements in guideline compliance using DANs | | 07:39–08:03| Example: Incorporation of vitamin D checklist and exercise guidance into notes | | 08:27–09:25| Practical advice on implementing DANs into health system workflows | | 09:41–10:49| Challenges of EHR integrations, limits of AI, and the case for provider-driven technology |

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Conclusion

Summary:
St. Elizabeth Healthcare’s use of Diagnosis Aware Notes transforms EHR workflows, making it easier for clinicians to adhere to current osteoporosis guidelines, document care comprehensively, and bridge critical care gaps for postmenopausal women. The episode balances optimism for EHR innovations with notes of caution regarding disruptive alerts and overreliance on AI, arguing for human-guided, guideline-driven technology solutions.

Final Word:
“Using technology, resources and innovations...needs to be informed by clinical guidelines and the knowledge of our provider community.” — Kristen Buessman ([10:49])

Transcript

[A]

Hello everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series today. So today's episode continues an important conversation on osteoporosis, shining a spotlight on how health systems can leverage new features within their EHR systems to improve care for postmenopausal osteoporosis patients. This episode is sponsored by Amgen, and with that, I will turn the floor over to Amgen's Kristen Buzeman, the director of IDM Strategy and Marketing. Kristen, take it away.

[B]

Hello everyone. It's a pleasure to be back here on the Beckers podcast again. So my name is Kristin Buessman and I am the health systems and key Accounts Marketing Director at Amgen for the US Bone Health franchise. My team and I are really focused on how we can understand challenges and opportunities to improve osteoporosis diagnosis and treatment for patients, particularly those that have experienced a fracture of. We're always happy to talk to leaders from health systems to better understand their challenges and to learn about strategies and solutions they're using to improve the health of this patient population. So today I'm really excited to be speaking with Dr. Barry Wendt from St. Elizabeth Healthcare. Dr. Wendt, would you like to introduce yourself for our listeners?

[C]

Absolutely. I'm Dr. Barry Wendt. I'm a practicing internist and I am the Chief Medical information officer at St. Elizabeth Healthcare.

[B]

Great. Thanks so much for joining me today to have this conversation. You know, we're really looking forward to seeing how you have been incorporating advances in electronic health records to improve postmenopausal osteoporosis care and just population health management in general at St Elizabeth? So let's jump right in. Before we get into the details, can you share a little bit of background on St. Elizabeth Healthcare and about the burden of osteoporosis that you've witnessed across your health system?

[C]

Absolutely. So St. Elizabeth Healthcare is a Catholic institution that was started in the 1800s, like many Catholic health care institutions in the Midwest, founded by a group of nuns and we've now significantly expanded. We have five hospitals, one in southeast Indiana and the rest in Northern Kentucky, and we're just across the river from Cincinnati. We have a physician group, multi specialty group that has more than 800 providers and 250 or, I'm sorry, 2500 associates. We have been distinguished with the unique award by U.S. news & World Report of being the number one hospital in Kentucky and I'm happy to say in the 99th percentile for physician satisfaction with their EMR. So for osteoporosis, you know, as a primary care physician, I see a variety of disorders, Postmenopausal osteoporosis being one of those that I see almost on a daily basis. And the challenging thing is many women are undertreated and we find that even though they're diagnosed, sometimes they're just put on calcium, vitamin D and given exercise, but not really put on the adequate therapy that they need. So that's a significant problem. After osteoporosis related fractures, postmenopausal women are five times more likely to suffer another fracture, and that risk remains high through the extent of their lifetime. What we're finding is many providers just can't keep up with the guidelines. In the last 10 years, there have been three new novel classes of drug and many drugs released to market, and the guidelines have changed. And with all the things you have to do in primary care and in many specialties, it's very hard to keep up. So we're trying to find novel ways to get providers to see the guidelines and pay attention to those and to be able to evolve with that. And so we're trying to get our providers to focus on when it's important to get a DEXA scan and when it's important to initiate treatment and to work on fall.

[B]

Prevention. Thanks so much, Dr. Wint, and congrats to the team at St. Elizabeth. Sounds like you guys are doing great work there. And your comments on the challenges faced in treating the osteoporosis patient population ring true to me as I talk to folks across the nation. I know in your role as CMIO at St. Elizabeth, you're really a champion of integrating EHR solutions to help address some of those care gaps that you were just mentioning. Can you tell us a little bit about Diagnosis Aware notes or they're referred to Dan's, is that.

[C]

Right? That's.

[B]

Correct. So what are dans? How do they function within an ehr and how can they really help.

[C]

People? So several years ago, EPIC or EHR came up with something called problem oriented charting, and that allowed providers to do their documentation based on problems. And one of the great breakthroughs with that was they incorporated something called diagnosis Aware notes, which is notes that follow a more natural workflow for the provider. They can document the way they did years ago with writing on paper in a natural workflow. And we were able to take some smart text and associate that with certain diagnoses, and that smart text drops in automatically and allows them to do their documentation. Much more efficiently. And embedded within that smart text, we're able to put guideline driven decisions that nudges providers to do the right thing and it will sort of guide them right through the clinical guidelines and provide kind of a template for them to use. It's greatly sped up documentation time. And the nice thing is we don't have to rely on BPAs that have been a sort of a pain for many of.

[B]

Providers. That's great. So they're kind of like a soft bpa, if you.

[C]

Will. Yeah. The great thing is it's decision making within that smart text. So it walks them through the guidelines as they're doing their note and that not only does it greatly speed up their time documenting, but it reduces their cognitive effort that they have to use and remembering now what is it I do for this diagnosis and what are the guidelines on this? It walks them right through that and it nudges them to the right.

[B]

Decisions. That's great. So it sounds like you were really an early adopter of Dan's and it sounds like you were kind of thinking about what would really benefit your providers across your system. You know, as you've introduced those stands across the system, how's that really changed the way osteoporosis is being treated and managed? Can you share any specific.

[C]

Examples? Yeah, so physicians have asked me to, you know, enhance these, make more of these, you know, not just for osteoporosis for many diagnosis, but it does help with that decision making. And I think we're finding much more compliance with the guidelines than we were prior to having these in.

[B]

Place. That's great. And I'm sure that there are other advantages too in terms of like making sure that all the right documentation is in place, you know, to assist kind of patient follow up and things like that as.

[C]

Well. One example is vitamin D levels are incorporated into the documentation. So if a patient hasn't had a vitamin D level checked, then the provider is immediately aware that that's not there and will place an order. So it also has, you know, some of the guidelines on exercise and things like that incorporated in there. So it really has enhanced the care we.

[B]

Provide. Well, and I know that there's a lot of care gaps for these osteoporosis patients, especially after a fracture. So it sounds like this is a really great way to help keep their care coordinated and simplify things for the providers as so one question for you on behalf of our listeners here is what advice would you have to folks that would be interested in including and incorporating Dan's into their.

[C]

Workflows. That's a great question. So diagnosis aware notes are extremely easy to use in associating a smart text with the diagnosis is also very simple. I would say it takes less time to read the guidelines than it does to build these inside RFAR ehr. So first you basically build out the template of what you want it to fit to the guideline and then associate it with a grouper for that specific diagnosis. For example, diabetes. You would associate it with a diabetes grouper within our EHR and then automatically that smart text will drop in and then it is basically just creating that nudge architecture. Usually we put the preferred medications at the top of the list and the preferred items are defaulted in. So it's very easy to build. Takes minutes really to build these.

[B]

Out. That's great. That's great. Let's take a step back and look at the bigger picture here. What challenges have you faced in integrating new technology into existing healthcare practices? And what future developments or improvements would you like to see in EHR systems to further enhance patient.

[C]

Care? Yeah, I think the challenges have been providers don't like disruptions during their workflow. And the great thing about these is they're non disruptive, unlike the pop up BPAs or even the soft BPAs that Epic has put into what's called the storyboard. That's become more or less a distraction because there's so many things now put into the storyboard. So this is a way of getting our providers to do the right thing by putting it into their natural workflow. So that's one great advantage. One of the challenges I think that we're going to face is all the AI that's creeping into healthcare. And the problem I see is that the AI might not pick up the appropriate guidelines or might not walk you through the steps the way these do. These are truly curated steps to walk the provider through that encounter. And I'm concerned a bit that we're going to be too reliant on AI and AI might not provide the correct answer. So I think that's where I see these of having a significant advantage and I think they're going to be around to stay for a.

[B]

While. Right. So what I'm hearing is we need to be using technology, resources and innovations, but it needs to be informed by clinical guidelines and the knowledge of our provider community. So this has been really great, Dr. Wind. We really appreciate these helpful insights. I know this is an area that is of interest not just for providers that are treating and managing osteoporosis patients, but beyond. So thanks so much for your insights, and thanks to the Becker's team for letting us be on your podcast again. Stay tuned for more insights on advancing post fracture care and post menopausal osteoporosis from Amgen. And thanks so much for our listeners for tuning.

[A]

In. Well, thank you so much, Kristen and Dr. Wendt for your time and this insightful conversation today. It's been a pleasure having you both on the podcast. And of course, we'd also like to thank today's sponsor, Amgen listeners. Please be sure to tune into more podcasts from Beckers by visiting our podcast [e-mail] this podcast was sponsored by Amgen. Participants have been compensated for their time by Amgen.