1. Asthma Care Program EMR Update & Next Steps Feb. 2013 Ann Taite BSc, CRA Project Manager, Asthma Care Program EMR Project Asthma Research Unit, Kingston General Hospital, Queen’s University M.D. Lougheed, MD, MSc, FRCP(C), Professor Departments of Medicine (Respirology), Biological and Molecular Sciences (Physiology) and Community Health and Epidemiology, Adjunct Scientist, ICES-Queen’s, Queen’s University, Kingston ON

2. Outline Summarize activities for 2012-13 Asthma Quality of Life Questionnaire Feasibility Study Plans to begin to make AQLQs available in primary care Plans to increase uptake of electronic Asthma Care Map Pan-Canadian REspriatory Standards INitiative for Electronic Health Record (PRESTINE) Next steps 2013-14 Phase 1: Make AQLQs available to PCAP Finalize data standards initiative: revised asthma and COPD care maps

3. AQLQ Feasibility Study Purpose To test the feasibility and utility of electronic Asthma Quality of Life Questionnaires in primary care in Ontario - -miniAQLQ (15- items) - -miniPAQLQ (13- items) - -PACQLQ (13- items)

4. AQLQ Feasibility Study Method Invited 3 primary care sites (27 locations) Providers given access to AsthmaLife ® – –signed on to Provider Portal using log on and password – –registered patients Consented patients (adult, pediatric) and caregivers signed on to Patient Portal using chart number and date of birth Patients completed AQLQ on the Patient Portal

5. AQLQ Feasibility Study

8. Mini AQLQ Olajos-Clow J et al. Respir Med 2010; 104(5) 658-67

9. AQLQ Feasibility Study Patients completed the AQLQ at beginning of asthma visit AQLQ results for current visit and all follow-up visits immediately available to the provider for review and discussion

10. Overall Score AQLQ Feasibility Study

11. Score by domain AQLQ Feasibility Study

12. Results Completed AQLQs: Adults (n=103), children (n=20), caregivers (n=11) Participant Satisfaction Survey – –Majority agreed or strongly agreed that eAQLQs were easy to access electronically and easy to read kiosk instructions were clear it is important to be asked how asthma affects their QoL Provider Satisfaction Survey – –Majority agreed or strongly agreed that eAQLQs provided additional useful information were useful for patient and program evaluation should be completed at every visit by patients using a virtual kiosk AQLQ Feasibility Study

13. Barriers to recruitment Internet access can be intermittent Time to consent and complete AQLQ Educators: room availability, space Enrolling for a another study in tandem AQLQ is not currently incorporated into the process of care

14. Plans to make AQLQs available in Primary Care Progress to date: Created a web-based system for eAQLQs on AsthmaLife® Participating providers can access their own site data eAQLQ user guide, patient and site eAQLQ reports are in development Next steps/Process issues: Central ‘repository’ for analysis/registry? Data sharing agreements? Informed consent? Reporting system design?

15. Plans to increase uptake of eAsthma Care Map Met with e-health and OntarioMD (July & Nov 2012) Provided overview of asthma initiatives Recommended to move forward: – –to integrate asthma/COPD care maps into EMR – –to establish a Respiratory Registry beginning with asthma and COPD – –to focus on data standards, programs and indicators – –3 rd meeting planned ‘how to increase functionality of electronic ACM’ Met with leadership team (OLA, MOH and researchers, Nov 2012) Discussed need to coordinate efforts to increase uptake of eACM and COPD care map and to establish a registry – –follow-up meeting planned April 2013

16. Pan-Canadian REspriatory Standards INitiative for Electronic Health Record (PRESTINE) Steering committee convened (Apr, June and Sept) – –representation from Nova Scotia, Quebec, Ontario & British Columbia – –primary care, specialists, epidemiology, researchers, administrators, information technology specialist – –Canada Health Infoway, CIHI, PCSSN, INESSS, OLA, CLA Statement of work, terms of reference and 3 year plan approved No funding to date eAQLQ working group to be established

17. Next Steps 2013-14 1. Implement a phased approach to make eAQLQs available to PCAP in collaboration with key stakeholders (OLA, PCAP, MOH) Change management plan phase 1: target PCAP sites engage site decision makers (champions) align with Health Quality Ontario initiatives focus on incorporating AQLQs into the processes of care make tools available to assist use (e-guide on how to use AQLQs) build in an incentive to encourage use of AQLQs (e.g. patient & site reports)

18. 2. Data Standards Initiative: revised asthma and COPD care maps In consultation with standards experts complete exercise to cross reference all data elements with SNOMED© and LOINC© address gaps in data standards Next Steps 2013-14