Translating Effective Paper-Based Disease Management into Electronic Medical Systems

We developed an innovative approach to computerize and integrate a previously-validated but paper-based asthma disease management program into an electronic medical systems. Asthma is the leading chronic disease of children and currently affects about 6.2 million (8.5%) children in the United States. National Asthma Education and Prevention Program (NAEPP) Guidelines recommend a multimodal chronic care approach. However, both the 1997 and 2007 NAEPP guidelines have not been widely adopted by primary care clinicians. Easy Breathing c is a cost-effective, asthma management program that has improved the quality of pediatric and adult asthma care, but uses paper and pencil dictations that have not been translated to an electronic format. When practices transition to an electronic health record (EHR), a paper-based program becomes cumbersome for clinicians to use in their new clinical workflow. Although integrating Easy Breathing into practice-based EHRs is most desirable, it is expensive and technically difficult as EHRs are proprietary and are the greatest barriers to continued use of the validated paper-based program. In this paper, we describe an informatics and software development model that translates Easy Breathing into a web-based system. This system is ready for integration into payer-provider web portals, such as the portals of Medicare/Medicaid vendors or private insurance companies. The availability of such a software system will allow clinicians to test the feasibility of using non-practice-based electronic systems that cut across different EHRs to integrate effective paper based disease programs. Our preliminary evaluation with a few healthcare professionals demonstrates that the resulting software is a streamlined and effective tool. Future clinical studies will be needed for system evaluation at the point of patient care.