The emergence of universal electronic prescribing and content knowledge vendors has laid the groundwork for incorporating indications into the CPOE prescribing process. As medication prescribing moves in the direction of inclusion of the indication, it is imperative to design CPOE systems to efficiently and effectively incorporate indications into prescriber workflows and optimize ways this can best be accomplished.

Background mHealth apps may be useful tools for supporting chronic disease management. Objective Our aim was to apply user-centered design principles to efficiently identify core components for an mHealth-based asthma symptom–monitoring intervention using patient-reported outcomes (PROs). Methods We iteratively combined principles of qualitative research, user-centered design, and “gamification” to understand patients' and providers' needs, develop and refine intervention components, develop prototypes, and create a usable mobile app to integrate with clinical workflows. We identified anticipated benefits and burdens for stakeholders. Results We conducted 19 individual design sessions with nine adult patients and seven clinicians from an academic medical center (some were included multiple times). We identified four core intervention components: (1) Invitation—patients are invited by their physicians. (2) Symptom checks—patients receive weekly five-item questionnaires via the app with 48 hours to respond. Depending on symptoms, patients may be given the option to request a call from a nurse or receive one automatically. (3) Patient review—in the app, patients can view their self-reported data graphically. (4) In-person visit—physicians have access to patient-reported symptoms in the electronic health record (EHR) where they can review them before in-person visits. As there is currently no location in the EHR where physicians would consistently notice these data, recording a recent note was the best option. Benefits to patients may include helping decide when to call their provider and facilitating shared decision making. Benefits to providers may include saving time discussing symptoms. Provider organizations may need to pay nurses extra, but those costs may be offset by reduced visits and hospitalizations. Conclusion Recent systematic reviews show inconsistent outcomes and little insight into functionalities required for mHealth asthma interventions, highlighting the need for systematic intervention design. We identified specific features for adoption and engagement that meet the stated needs of users for asthma symptom monitoring.

Key Points Question Is a redesigned electronic prescribing workflow to better support the incorporation of the indication in the outpatient prescribing process associated with reduced errors and improved clinician experience? Findings This quality improvement study compared an indications-based electronic prescribing prototype with that of 2 leading electronic health record vendors and found that the usability of the prototype system substantially outperformed both vendors’ prescribing systems in terms of efficiency, error rate, and satisfaction. Meaning Reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way and may be associated with saved time and effort, reduced errors, and increased clinician satisfaction.

The new tool substantially improved efficiency, accuracy, and usability. It was subsequently integrated into the electronic health record and rolled out system-wide. This project provides an example of how clinical and informatics teams can innovative alongside a commercial Electronic Health Record (EHR).

Background: Asthma is a heterogeneous inflammatory disease of the airway, characterized by airway hyperresponsiveness, airway obstruction, mucus hyperproduction, and airway-wall remodeling. Management of this disease involves the use of several types of therapeutic agents, each with unique indications based on the underlying cause of inflammation, clinical severity, and patient phenotype and/or endotype. Objective: A review of the function, clinical utility, and safety of biologic agents in the management of allergic asthma. This particular asthma phenotype involves multiple cytokines in its pathogenesis, specifically those secreted by T-helper type 2 cells. Methods: Medical literature was obtained from online biomedical archive searches from July 2018 to May 2019. An emphasis was placed on clinical trials that discussed biologic agents that target immunoglobulin E, interleukin (IL) 5, IL-4/IL-13, and chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTh2) pathways involved in the expression of allergic asthma. Results: The treatment options reviewed in this article were shown to be effective in targeting these pathways associated with allergic asthma. However, because these biologic agents are commonly prescribed in the treatment of severe asthma, many patients continue to experience asthma signs and symptoms. Conclusion: Future clinical trials that study these agents should focus on ideal patient selection, dosing regimens, and cost-effectiveness in the management of asthma. Ideally, comparative trials should be undertaken to assist the clinician in choosing the optimal agent.