Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System

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Asthma is an airway obstruction disease that is prevalent among children and adults of any age triggered by different types of allergens. The treatment options for this condition have been defined according to the severity of the illness. There are guidelines that many physicians follow in order to reduce asthma exacerbation. However, there are reports from the CDC that its prevalence has been increasing in the past several years. [1] The purpose of this article is to integrate Evidence-based medicine (EBM) in the EHR through a decision support tool named Asthma Action Plan (AAP). This is a tool designed for patients to assist them with self management of the disease. Although, AAP has demonstrated through other studies that this tool has helped reduce asthma exacerbation and complications, there continues to be a lack of compliance and continuity from the providers. Therefore, the goal is to streamline the EBM guidelines for Asthma through the EHR system and evaluate the effectiveness of the AAP throughout the institution.


  • Setting: Carolinas HealthCare Institution: covers 40 hospitals and over 900 care locations
  • eAAP development: This tool was developed in 4 phases.
     Phase 1: web based prototype
     Phase 2: a multidisciplinary team created to integrate this tool into the EHR.
     Phase 3: pilot study at 5 primary care settings.
     Phase 4: dissemination and implementation in over 100 primary care settings.


Data was collected and evaluated through the EHR system and billing department by identifying patients with a diagnosis of asthma. "Electronic asthma action plan decision support tool (eAAP) usage per month across the health care system’s primary care outpatient network from December 2012 through September 2014, a total of 6484 eAAPs were completed. The tool was used at 30 to 40 outpatient practices each month by October 2013."[1] Overall, the results showed a reduction in asthma exacerbation in children who used the eAAP over a time of 12 months. This included reduced emergency department visits, oral use of steroids and hospitatlizations. However, in adults there was not a significant reduction.


The probable cause of the results being greater in children was that the plan was mostly focused on prediatrics. The integration of Evidence-based medicine in the EHR is progressing in many areas of medicine such as chronic disease that need evidence based guidelines to prevent complications in patients. "Studies show improvements in preventive care services, appropriate care, clinical outcomes, and cost when providers have access to current medical knowledge and evidence-based guidance at the point of care".[1]


Guidelines integrated into the EHR system and its implementation can produce better healthcare outcomes and can be cost-effective by preventing prolonged hospital stays and readmissions.

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  1. 1.0 1.1 1.2 Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System,,Lindsay Kuhn, MHS, PA-C, Kelly Reeves, BSN, RN, Yhenneko Taylor, PhD, Hazel Tapp, PhD, Andrew McWilliams, MD, MPH, Andrew Gunter, MD, Jeffrey Cleveland, MD, and Michael Dulin, MD, PhD,The Journal of the American Board of Family Medicine, 28(3), 382-393