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A1490 - Electronic Medical Records in Interstitial Lung Disease: Implementation of Monitoring Flowsheets for Lung Physiology
Author Block: F. Chowdhury1, E. Saad1, S. Stenson2, N. Hait2, M. Kalluri1, J. Yehya1, E. Y. Wong1, T. Graham2, R. Hayward1, D. P. Vethanayagam1; 1Department of Medicine, University of Alberta, Edmonton, AB, Canada, 2Alberta Health Services, Edmonton, AB, Canada.
Rationale: eCLINICIAN is an enterprise ambulatory care Electronic Medical Record (EMR) system hosted by Alberta Health Services (AHS) in the Edmonton Zone for most of the last decade. Clinician leadership of clinical applications of the EMR has proved essential to engagement and benefits realization. Use of pulmonary function tests (PFT) to assess pulmonary physiology is important for effective management and monitoring of patients with interstitial lung disease (ILD). Integration of physiologic data into clinical decision-making relies upon perception of change and detection of trends. Facilitating pattern detection in large datasets can improve care through early recognition of need for therapy, evaluating response to treatment changes, personalized prognostication and targeted patient education, and engagement. A pulmonary physiology documentation flowsheet was developed, implemented, and evaluated in an effort to promote more effective decision-making by front line clinicians.
Methods: High needs ILD patients followed by pulmonologists in the Kaye Edmonton Clinics (KEC) were selected using a survey and systematic consensus-building process. An electronic pulmonary physiology flow-sheet tool was developed for PFT data abstracted and entered by a nurse practitioner. A prototype was iteratively modified over a 12-month period then subjected to peer-review and optimization before implementation. A post implementation survey was also conducted.
Results: The eCLINICIAN pulmonary physiology flowsheet has been integrated into chronic disease management for 38 ILD patients. The time taken for PFT data abstraction averaged 5 minutes and patients averaged a total of 5 PFT sets (range 1-26). Clinicians received the tool positively and reported that it facilitated clinical decision-making. The post-implementation survey highlighted important challenges related to manual data entry of PFT data. This process can be time-consuming, labor-intensive, and prone to error (i.e. data strike errors). Comparing ILD to other respiratory conditions, it appears the flowsheet tool may present substantial resource issues (related to manual data entry) for ILD care vs. airways diseases (asthma, bronchiectasis and chronic obstructive pulmonary disease).
Conclusion: The ILD pulmonary physiology flowsheet has been successfully integrated into care for ILD patients within the eCLINICIAN EMR. However users need improved electronic tools to take source physiology data to the EMR flowsheets that are automatically generated. This needs assessment is an important stepping-stone for justifying transitional software to enable this function. Use of the pulmonary physiology electronic flowsheet for persons with ILD can potentially improve EMR workflow and clinician efficiency while improving the quality of ILD chronic disease management.