Incorporating an electronic Asthma Action Plan (e-AAP) into an Electronic Health Record -or- Bringing clinical guidelines to the point of care

1
Incorporating an electronic Asthma Action Plan
(e-AAP) into an Electronic Health
Record-or-Bringing clinical guidelines to the
point of care

• Gail M Brottman MD
• Director, Pediatric Pulmonary Medicine. Hennepin
  County Medical Center
• Co-PI HIT Asthma Project

Yiscah Bracha, MS Research Director, Center for
Urban Health. Mpls Medical Research
Foundation Project Director HIT Asthma Project
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Asthma An Important Chronic Disease

• 17m asthmatics in the US rising1
• Every year, asthmatics have
• 2 million emergency room visits2
• 500,000 hospitalizations2
• Estimated costs
• Direct 9.4 billion
• Indirect 4.6 billion3
• Asthma mortality rates gt doubled 1979-1990s2

1. National Institute of Allergy and Infectious
   Disease. Focus on Asthma. http//www.niaid.nih.gov
   /newsroom/focuson/asthma01/default.htm.
2. National Institute of Allergy and Infectious
   Disease. Focus on Asthma. http//www.niaid.nih.gov
   /newsroom/focuson/asthma01/basics.htmstats.
3. American Lung Association Fact Sheet Asthma in
   Adults. March 2003. Available at
   http//www.lungusa.org/asthma/aduasthmfac99.html.

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People suffer with poorly controlled asthma

• Daily impairment from asthma
• Missing school or work 49 of children, 25 of
  adults
• Waking with breathing problems at least weekly
  30
• Limited participation in
• Sports recreation (48)
• Normal physical exertion (36)
• Social activities (25)

Researchers for Asthma in America
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To Achieve Asthma Control

• Patients need to
• Avoid asthma triggers
• Use daily medication to reduce lung inflammation
• Know what to do if developing increased asthma
  symptoms
• Use quick relievers
• Start oral corticosteroids if necessary

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How do providers help patients achieve asthma
control?

• NAEPP EPR-3 guidelines recommend
• Use standardized approach
• Prescribe daily meds based on symptom severity
• Teach patients about different asthma meds
• What a controller is and when to take it
• What a reliever is and when to take it
• Show patients how to use an inhaler
• Give patients a written plan for what to do every
  day, what to in case of distress

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NAEPP Asthma Guidelines

• Most recent release in 2007 (EPR-3)
• Lengthy written document
• 417 pages of narration references
• Organized by topic rather than workflow
• Recommendations difficult to summarize
• Lack of usable summary inhibits implementation
  during patient care

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e-AAP Asthma decision support from EHR

• Guidelines translated into executable code
• Launched during patient encounter from EHR
• Facilitates assists
• Focused patient-provider communication
• Treatment plan/medication selection
• Produces
• Written (English or Spanish) chronic care
  document (Asthma Action Plan)
• Progress note for provider documentation

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Sample screen Assessing asthma control
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My Asthma Action Plan
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Written AAP Part of the EHR

• Important chronic care document
• Daily meds for asthma control
• Patient actions in response to increased symptoms
  respiratory distress
• Clinic provider names telephone numbers
• Follow-up time.
• Asthma registry created
• Facilitates asthma QI and population management

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Summary

• e-AAP A novel technology that brings clinical
  guidelines to the point of care
• Development identified key issues for guideline
  dissemination in the Age of EHRs
• E-AAP has good potential to improve
  patient-provider communication and patient
  activation, but further evaluation is needed
• For more information go to our website
  http//www.e-aap.net

Summary
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HIT Asthma Team

• Prime contractor  Denver Health and Hospital
  Association.
• Subcontractor  Minneapolis Medical Research
  Foundation. Project site Hennepin County
  Medical Center, Mpls MN
• AHRQ Contract No. HHSA290200600020, Task Order
  No. 5

Staff Denver Health and Hospital
Association Sheri Eisert, PhD (Director, Health
Services Research) Michael (Josh) Durfee
(Research Projects Coordinator, Health Services
Research)
Staff and contractors Minneapolis Medical
Research Foundation Gail Brottman, MD (Director,
Pediatric Pulmonology, HCMC) Kevin Larsen, MD
(Chief Medical Informatics Officer, HCMC) Yiscah
Bracha, MS (Research Director, Center for Urban
Health) Cherylee Sherry, MPH (Project Manager,
Pediatric Research Advocacy HCMC ) MaryAnn
Jagodzinski, RN (Implementation
Coordinator) Touch Thouk (Administrative Manager,
Center for Urban Health) Angeline Carlson, PhD
(Principle, Data Intelligence Inc.)
Contributors of Ideas, Information Effort
Michael Barbouche (University of Wisconsin
Medical Foundation) Robert Grundmeier, MD
(Childrens Hospital of Philadelphia) Michael
Kahn, MD, PhD (Denver Childrens Hospital) Donald
Uden, PharmD (University of Minnesota), Faith
Dohman, RN (Hennepin Faculty Associates) Susan
Ross, RN (Minnesota Department of Health)