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Gail M Brottman MD Director, Pediatric Pulmonary Medicine. Hennepin County Medical Center

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

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Gail M Brottman MD Director, Pediatric Pulmonary Medicine. Hennepin County Medical Center

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  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

  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.

  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™

  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

  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

  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

  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

  8. Sample screen: Assessing asthma control Sample screen: Assessing asthma control

  9. My Asthma Action Plan

  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

  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: http://www.e-aap.net Summary

  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)

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