New Jersey’s largest health network launched a new care model aimed at reducing preventable complications for hospitalized patients with Parkinson’s disease.
Hackensack Meridian Health rolled out a Parkinson’s Disease Care Pathway, developed in collaboration with the Parkinson’s Foundation, that embeds specific safety measures into its electronic health record system. According to the Parkinson’s Foundation, 1 in 6 people hospitalized with Parkinson’s experience an avoidable complication related to medication management, mobility or dysphagia.
Annie Brooks, senior director of strategic initiatives at the Parkinson’s Foundation, tells HealthStack the new EHR-based care model could provide a practical way to improve patient outcomes.
“We have invested in both the development of the dashboard to analyze the impact and in the development of a toolkit that will help other health systems replicate the order set,” Brooks says.
Health systems across the nation are increasingly using EHRs to build clinical protocols directly into the care process. Hackensack’s model could pave the way for other health systems adopting Parkinson’s-specific protocols into inpatient workflows.
Hackensack Meridian Health’s Focus On Hospitalizations
Hackensack Meridian Health’s EHR pathway for Parkinson’s includes custom medication orders based on each patient’s home regimen. An electronic alert flags key areas and protocols to care teams, reducing the risk of symptom worsening during hospitalization.
“EHR-based Parkinson’s disease care pathways, like ours at Hackensack Meridian Health, standardize inpatient care through several key interventions designed to prevent common, life-threatening failures in hospitalized patients living with Parkinson’s,” says Dr. Hooman Azmi, the director of the Division of Functional and Restorative Neurosurgery at Hackensack University Medical Center’s Neuroscience Institute.
The health system reported promising early results, with the pathway doubling compliance in customized Parkinson’s medication orders. In a news release, the large care provider shared that their goal is to reduce reliance on individual memorization of each patient’s specialized needs. Their new system uses protocol to design individual care plans that nurses and physicians can follow for each patient.
The prevalence of Parkinson’s has doubled over the past 25 years. However, there is no FDA-approved or otherwise proven disease-modifying treatment that stops or slows disease progression. Treatment currently focuses on symptom management.
However, patents can rapidly deteriorate in hospital settings. The Parkinson’s Foundation describes this as a “Symptom Spiral, a self-reinforcing cycle where physical or psychological triggers worsen symptoms.
How The Parkinson’s Care Pathway Works
The Parkinson’s care pathway is built directly into the EHR, bringing Parkinson’s-specific care into the hospital workflow. Following admission of a patient with Parkinson’s, an automated order set flags the diagnosis for the care team. It then provides guidance on medication timing, medication safety, mobility and swallowing.
The Parkinson’s Foundation is working to help health systems address these risks through its Hospital Care Recommendations. This initiative identifies five standards for keeping people with Parkinson’s safe during hospitalization.
“A care pathway or order set built into the EHR is a promising approach to integrating multiple interventions into a single tool that is easy for clinicians to access and navigate,” Brooks explains.
Hackensack Meridian Health’s pathway focuses on four areas that contribute to hospital stay complications. These areas are medication timing, potentially harmful medications, mobility, and swallowing and aspiration risk.
Medication Timing
Parkinson’s medications often follow a specific schedule at home. Delayed or missed doses can worsen movement symptoms and make it harder for patients to participate in rehabilitation.
The pathway uses the patient’s home medication schedule when creating hospital orders. Hackensack Meridian Health instructs clinicians to administer Parkinson’s medications within 30 minutes of the scheduled time. The pathway also uses customized orders rather than relying solely on standard hospital medication schedules.
Medication Safety
The EHR also alerts clinicians to medications that can worsen Parkinson’s symptoms. These include certain dopamine-blocking drugs commonly used to treat nausea, agitation and other conditions.
The alert is particularly relevant when patients are admitted for conditions unrelated to Parkinson’s. The admitting team may need to prescribe medications for the immediate reason for hospitalization while also accounting for the patient’s Parkinson’s treatment.
Mobility And Falls
The pathway calls for patients to move at least three times a day when medically appropriate. The EHR also includes guidance related to fall prevention.
Limited movement can worsen Parkinson’s motor symptoms and increase the risk of complications during a hospital stay. Keeping patients mobile can also help prevent problems associated with prolonged inactivity.
Swallowing And Aspiration
Swallowing problems are common in Parkinson’s and can increase the risk of aspiration. The pathway incorporates swallowing precautions into the hospital workflow.
Hackensack Meridian Health instructs patients to remain upright and out of bed for meals when appropriate. The pathway also includes guidance for swallowing complications and aspiration prevention.
Transforming Hospital Workflows
In practice, Parkinson’s care can vary across health systems and clinician teams. The new pathway could help shift responsibility from individual clinicians to the hospital’s care infrastructure. The Parkinson’s-specific guidance gives providers a shared framework for managing patients during hospitalization.
Nurses also will receive clearer guidance on medication administration, mobility and meal positioning. They won’t have to relying on separate reminders or manual checks to ensure patient safety.
The Parkinson’s Foundation cautions that a single standardized approach may not work across every health system. “Every hospital and health system has unique elements that make a truly standard approach across the American health system challenging,” Brooks says.
The Foundation instead provides recommendations that can be implemented in different ways based on the strengths and realities of individual institutions.
For hospitals considering similar approaches, Brooks says they do not have to build these systems alone. The Foundation is partnering with more than 50 health systems to implement best practices with the goal of helping organizations adopt approaches without having to “reinvent the wheel.” The organization is also measuring the impact of current EHR pathways to help set an approach in developing tools that could help other health systems.
“The one-year data-collection phase will be completed in June 2027, and then we’ll know how use of the Order Set has impacted care and outcomes for people with Parkinson’s disease,” she shares.
Early Results Show Promise
Early research supports the use of electronic tools and standardized protocols for some aspects of inpatient Parkinson’s care. A study published in Frontiers in Aging Neuroscience found that hospitals have developed different electronic tools and workflows to identify patients with Parkinson’s, support customized medication orders and flag potentially harmful medications. The researchers also noted challenges in developing standardized approaches to inpatient care.
Other research has linked standardized hospital protocols to improved outcomes. In a study of hospitalized patients with Parkinson’s disease, researchers found that a hospital-wide protocol focused on customized medication timing and avoiding contraindicated drugs was associated with shorter hospital stays.
Research from Hackensack University Medical Center also examined 31,404 Parkinson’s medication orders. Customized orders made medication administration 1.4 times more likely to occur within 15 minutes of the scheduled time and 1.33 times more likely within 30 minutes, compared with standard orders.
