J Am Board Fam Med
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Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. ⋯ This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.
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We have improved access to specialist care and decreased wait times in our region through the development and implementation of the Champlain BASE (Building Access to Specialists through eConsultation) service. This secure, web-based tool allows primary care providers (PCPs) quick access to specialist advice for their patients and often helps to avoid the need for a face-to-face referral. Our successful implementation of eConsult in our region provides a unique opportunity to examine PCPs' satisfaction and overall perspective on using the service. ⋯ PCPs showed a high level of satisfaction with eConsult's quick turnaround time and quality of specialist advice. Our results illustrate the advantages of using asynchronous virtual platforms to increase access to specialty care from a PCP perspective.
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Submission of clinical quality measures (CQMs) data are 1 of 3 major requirements for providers to receive meaningful use (MU) incentive payments under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Some argue that CQMs are the most important component of MU. Developing an evidence base for how practices can successfully use electronic health records (EHRs) to achieve improvement in CQMs is essential and may benefit from the study of exemplars who have successfully implemented EHRs and demonstrated high performance on CQMs. ⋯ Purposeful use of EHR functionality coupled with staff education in a milieu where QI is valued and supported is associated with higher performance on CQM.
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Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. ⋯ Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.
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Response rates to point-of-care clinical reminders typically decrease over time. We hypothesized that this "reminder fatigue" could be prevented by (1) applying sound human factors engineering and cognitive science principles in designing the reminder system, and (2) implementing the reminders with rigorous attention to organizational science principles. ⋯ Reminder fatigue over time, with increasing numbers of reminders and with increasing complexity of patients, is not inevitable. A reminder system designed and implemented in accordance with the principles of cognitive science and human factors engineering can prevent reminder fatigue.