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Andrew Cave

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  • OS05 - Connecting Data in Meaningful Ways (ID 5)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/05/2017, 04:00 PM - 05:30 PM, Room 203AB
    • OS05.02 - Improving Community Paediatric Asthma Care with EMR Algorithm and Tools (ID 327)

      Andrew Cave, Family Medicine, University of alberta; Edmonton/CA

      • Abstract
      • Slides

      Purpose/Objectives: Asthma management for children in primary careis suboptimal despite guidelines. Management can be improved by point of care prompting. The Asthma Working Group (AWG) purpose was to provide and test a template for asthma management for primary care physicians (PCPs) to structure their management according to guidelines.

      Methodology/Approach: An asthma management algorithm was developed by a panel of experts in one Canadian province. Several iterations were developed of algorithms for (1) approach to first diagnostic visit (2) management of follow up visits of viral induced and (3) allergy induced phenotypes of asthma and(4) management of acute exacerbations. These paper-based algorithms were reviewed by groups of PCPs for content and presentation. Consensus was that even brief paper based formats would not be used regularly. 85% of PCPs have Electronic Medical Records (EMRs) for charting; therefore templates were developed that could be inserted into the EMR for point of care patient management. One EMR vendor provides the software for 80% of primary care practices in the province using one of three programs. The AWG consulted them to upgrade the first templates. It was soon apparent that much more was possible than the AWG had envisioned and a working partnership was developed with the EMR vendor. Through this partnership the AWG improved the template design and added a population management dashboard to enable proactive management processes and usability. To test the templates, 23 primary care practices were recruited and randomised to receive the asthma management education and the EMR tools. Clinical and process indicators for childhood asthma are captured within the dashboard for the PCP to review, analyse or act upon. Dashboard statistics can be shared by the PCP with the AWG support team, which then returns the peer average in the PCP's dashboard trends. The dashboard indicators provide insight to the AWG team to validate the asthma templates adoption, identify areas for coaching to reinforce best practices and assist with future program planning. Additional resources are accessible for template use via an integrated educational package.

      Finding/Results: Four templates have been produced and approved by clinician members of the AWG incorporating free flow algorithms and are supported by a quality improvement dashboard. These have been inserted into 11 practices that use one of two EMR systems.

      Conclusion/Implication/Recommendations: If the randomised trial outcomes show that the templates improve the management of asthma in children, the templates will be offered to all PCPs in the province who use any of the three systems (over 3000 PCPs covering over 70% of paediatric patients with asthma). Feedback from participating PCPs will enble modification of the templates before going province wide. The fact that the EMR vendor covers so many of the practices through the three systems will be a major facilitator of this roll out. Provincial working groups for Chronic Obstructive Pulmonary Disease (COPD) and for diabetes have expressed an intention to use the same approach for improving management of those conditions in primary care.

      140 Character Summary: Pediatric asthma management templates and tools were developed and inserted in primary care EMRs by a clinician/vendor partnership. Other conditions will follow.

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