Improving Food Allergy Management through an Electronic Physician Support Tool

rationale: Food allergy is a growing and potentially life-threatening concern that affects an estimated 8% of US children. Primary care clinicians are often the first resource for affected families and play a critical role in diagnosis.  The NIAID developed guidelines to better manage childhood food allergy; however, primary care clinicians in the US still have many misconceptions regarding food allergy management in practice.  Thus, the goal of this project is to develop and evaluate the feasibility and efficacy of an electronic clinical decision support tool to improve the diagnosis and management of food allergy in the primary care setting.   

methods: An expert panel of researchers, pediatricians, allergists, and epic consultants were convened to review the NIAID guidelines, current pediatric practices around food allergy, and develop a simplified decision model for clinicians.  This model was then converted into a clinical decision support tool in EPIC.  Qualitative data was collected on the development of the tool itself.  To educate clinicians on the support tool, an educational music video was developed.

results: We distilled the NIAIDs guidelines into a 5-step protocol for primary care clinicians: 1) clinical history of reactions, 2) diagnostic testing and test interpretation, 3) medication prescription for epinephrine auto-injectors and other medications, 4) counseling and education for patients/caregivers including providing a food allergy emergency action plan, and 5) referral to an allergist. A preliminary decision support tool was built in EPIC and a paper-based tool was developed for clinics without EPIC.  To date, the tool has been integrated in 2 primary care clinics and 15 clinicians have been trained.   

conclusions: The clinical decision support tool has the potential to improve the primary care diagnosis and management of food allergy if properly integrated into the workflow of clinicians.