Incorporating an Electronic Asthma Action Plan (e-AAP) into an Electronic Health Record-or-Bringing Clinical Guidelines to the Point of Care (Text Version)

On September 16, 2009, Gail M Brottman and Yiscah Bracha made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (332 KB).

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Slide 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
 

 

Slide 2

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 > doubled: 1979-1990s2

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

 

Slide 3

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™

 

Slide 4

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

 

Slide 5

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

 

Slide 6

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

 

Slide 7

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

 

Slide 8

Sample screen: Assessing asthma control

 

Slide 9

My Asthma Action Plan

Image: Screen shot of My Asthma Action Plan

 

Slide 10

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

 

Slide 11

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: www.e-aap.net

 

Slide 12

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 (Children's Hospital of Philadelphia); Michael Kahn, MD, PhD (Denver Children's Hospital)
Donald Uden, PharmD (University of Minnesota), Faith Dohman, RN (Hennepin Faculty Associates); Susan Ross, RN (Minnesota Department of Health)