PURPOSE: To expand utilization of disease-specific EMR templates for outpatient asthma management, promote adherence to NAEPP evidence-based practice guidelines, and facilitate quality improvement initiatives in the care of adult asthma patients.
METHODS: Three modified GE Centricity/CCC asthma EMR HPI templates ("asthma", "severity", and "exacerbation") were in place for outpatient asthma management in a large suburban pulmonary / allergy practice. Patients completed the validated "Asthma Control Test" (ACT), and clinical staff recorded the scores in a customized EMR pulmonary flowsheet. To incorporate the assessment of asthma risk and impairment in accordance with 2007 NAEPP guidelines, 3 pulmonary APN’s adapted and customized two additional templates available within this EMR system: "asthma severity and control" and the "asthma management plan" (AMP). Physician training on template navigation and use was conducted by the APN’s at 3 office sites in 15-30 minute 1:1 sessions.
RESULTS: Between January 1 and March 8, 2010, there were 791 initial visit and follow-up office encounters for asthma by 10 physicians and 2 APN’s. Asthma severity (intermittent, mild persistent, moderate persistent, or severe persistent) was documented for 110 patients (13.9%), and the AMP was completed in 104 (13.1%). Clinical staff entered an ACT score for 308 patients (38.9%) The level of asthma control (well controlled, poorly controlled, or very poorly controlled) was documented by the provider at 31 visits (3.9%).
CONCLUSION: While EMR templates provide the framework for adherence to evidence-based guidelines, providers in clinical practice demonstrate poor compliance with documentation of asthma severity and control and formulation of AMP’s. Clinical staff demonstrated a higher level of consistency in documenting patients’ subjective ratings of asthma control using the ACT.
CLINICAL IMPLICATIONS: Reasons for underuse of the expanded asthma templates may include insufficient provider knowledge of the NAEPP guidelines, perceived limitations of template utility, and slow adaptation to EMR workflow. Additional provider education is needed on documentation of asthma severity and control to facilitate optimal clinical decision making for evidence-based, stepwise treatment of asthma.
DISCLOSURE: Marilyn Borkgren-Okonek, No Financial Disclosure Information; No Product/Research Disclosure Information