e-IRON: Iron-Deficiency Anemia Management at Warp Speed

A telemedicine pilot program to triage and expedite the management of patients with iron-deficiency anemia (IDA) who require intravenous (IV) iron allowed clinicians to determine appropriate management rapidly, avoiding the traditional time-consuming consultation process. Results of the pilot program were presented by Mark Chaitowitz, MD, from Albert Einstein College of Medicine in New York, at the 2020 American Society of Hematology Annual Meeting.

IV iron is a rapid, reliable, and safe strategy in addressing IDA, but “historically, at our institution and at many others, the path to IV iron treatment entails initial referral to hematology, a face-to-face evaluation at a hematology clinic, followed by scheduling for infusion on another visit,” Dr. Chaitowitz explained.

At Montefiore Medical Center in New York, Dr. Chaitowitz and colleagues developed the e-IRON program to reduce inappropriate delays and decrease the time from referral to infusion. The e-consult platform was made available to referring providers within the institution’s electronic medical record system to facilitate an electronic referral to hematology for consideration for IV iron.

The program uses a template-based design to ensure that all information required (indication, experience with oral iron, current lab work, etc.) is included, Dr. Chaitowitz explained. After being submitted through the platform, e-IRON referrals are reviewed by a specialist hematologist within three business days, and a determination regarding IV iron is made. If deemed appropriate, the patient is scheduled for infusion within 10 business days. The specialist also specifies whether a face-to-face hematology appointment is required. In cases where IV iron is not deemed appropriate, the hematologist will provide guidance as to alternate management.

The e-IRON program was evaluated in an initial 75-day evaluation period, during which 81 referrals were received. The most common referrals were for anemia in pregnancy and IDA that is not responsive or intolerant to oral iron.

Results of the hematologist review of the cases were as follows:

  • IV iron is indicated: 58 instances
  • IV iron is indicated, along with a face-to-face appointment: 2 instances
  • Lab work not current (complete blood count/iron studies older than 30 days): 7 instances
  • More information needed: 3 instances
  • Treatment other than IV iron recommended: 11 instances

Nearly all the recommendations (n=77; 95%) were generated within three business days, and within one day for more than half of patients (n=47; 58%). Recommended IV iron regimens all entailed one or two infusion days, depending on the estimated iron deficit, and all first infusions were scheduled within two weeks of the request.

“Reasons for non-approval of IV iron varied, but the most common reason cited was an inadequate trial of oral iron, in which case specific instructions were provided for oral iron supplementation,” Dr. Chaitowitz noted.

Based on this experience, Dr. Chaitowitz concluded that the e-IRON pilot project demonstrates the feasibility and efficacy of a telemedicine approach in triaging and expediting the management of patients requiring IV infusion. “The platform ensures effective supervision by specialist hematologists, but dispenses with the laborious, costly, and time-consuming traditional requirement of a face-to-face visit to the hematology clinic,” he concluded. “The value of this paradigm shift in patient care is underscored by lessons learned during the ongoing COVID-19 pandemic.”

Study authors report no relevant conflicts of interest.

Reference

Wilson C, Lee W, Cook M, et al. E-Iron: rethinking the way we deliver intravenous iron. Report of a pilot telemedicine initiative. Abstract #425. Presented at the 2020 American Society of Hematology Annual Meeting, December 6, 2020.