Impact of an electronic health record on the promotion of NIH asthma guidelines in the primary care setting

In 2002 the NIH's National Heart, Lung and Blood Institute published recommendations for asthma evaluation and management. These guidelines serve to facilitate the practitioner's assessment of a patient's asthma status and severity. Research has shown that provider compliance with documentation of recommended medical guidelines is often low. This low compliance may result in poor patient outcomes. Concerned with the need to adequately document all essential asthma variables, the Children's Health Fund's-Childhood Asthma Initiative (CAI) incorporated a modification of the NIH asthma guidelines into the electronic health record (EHR) utilized by the organization's pediatric and family practice physicians. This electronic asthma template serves as a prompt for providers to document fundamental asthma variables, i.e., number of ER visits, hospitalizations, severity classification and controller medication use. CAI is analyzing the degree of documentation of asthma variables among 7 pediatric providers at an urban federally qualified medical group in NYC. A total of 200 charts are being reviewed for documentation of asthma variables within a contiguous 20-month time period. The chart review will examine 100 patient records for asthma variable documentation before the introduction of the EHR prompt and 100 patient records after the prompt was integrated into the EHR system. A preliminary review of 40 patient records reveals an over 60% improvement in the documentation of asthma variables following the introduction of the EHR prompt. The use of prompted assessment tools within an electronic health record can positively impact provider use of evidence-based algorithms.