Pan-Canadian Respiratory Standards Initiative for Electronic Health Records (PRESTINE): 2011 National Forum Proceedings

Abstract

In a novel knowledge translation initiative, the Government of Ontario's Asthma Plan of Action funded the development of an Asthma Care Map to enable adherence with the Canadian Asthma Consensus Guidelines developed under the auspices of the Canadian Thoracic Society (CTS). Following its successful evaluation within the Primary Care Asthma Pilot Project, respiratory clinicians from the Asthma Research Unit, Queen's University (Kingston, Ontario) are leading an initiative to incorporate standardized Asthma Care Map data elements into electronic health records in primary care in Ontario. Acknowledging that the issue of data standards affects all respiratory conditions, and all provinces and territories, the Government of Ontario approached the CTS Respiratory Guidelines Committee. At its meeting in September 2010, the CTS Respiratory Guidelines Committee agreed that developing and standardizing respiratory data elements for electronic health records are strategically important. In follow-up to that commitment, representatives from the CTS, the Lung Association, the Government of Ontario, the National Lung Health Framework and Canada Health Infoway came together to form a planning committee. The planning committee proposed a phased approach to inform stakeholders about the issue, and engage them in the development, implementation and evaluation of a standardized dataset. An environmental scan was completed in July 2011, which identified data definitions and standards currently available for clinical variables that are likely to be included in electronic medical records in primary care for diagnosis, management and patient education related to asthma and COPD. The scan, sponsored by the Government of Ontario, includes compliance with clinical nomenclatures such as SNOMED-CT® and LOINC®. To help launch and create momentum for this initiative, a national forum was convened on October 2 and 3, 2011, in Toronto, Ontario. The forum was designed to bring together key stakeholders across the spectrum of respiratory care, including clinicians, researchers, health informaticists and administrators to explore and recommend a potential scope, approach and governance structure for this important project. The Pan-Canadian REspiratory STandards INitiative for Electronic Health Records (PRESTINE) goal is to recommend respiratory data elements and standards for use in electronic medical records across Canada that meet the needs of providers, administrators, researchers and policy makers to facilitate evidence-based clinical care, monitoring, surveillance, benchmarking and policy development. The focus initially is expected to include asthma, chronic obstructive pulmonary disease and pulmonary function standards elements that are applicable to many respiratory conditions. The present article summarizes the process and findings of the forum deliberations.

The revised 2014 GINA strategy report

“…Didactic teaching and Asthma textbook-style documents are known to be ineffective; a first step is to provide recommendations that are clinically relevant, clearly described and feasible for implementation into day-to-day practice, and this was a key focus during preparation of the GINA 2014 report. Behaviour change can also be facilitated by integrating recommendations into healthcare systems, for example in using embedded recommendations in Electronic Medical Records [29], in order to reduce barriers to change.…”

Pan-Canadian asthma and COPD standards for electronic health records: A Canadian Thoracic Society Expert Working Group Report

“…EHRs and EMRs are increasingly prevalent, particularly in primary care, and represent a novel opportunity to integrate guidelines into day-to-day practice. 8 The potential benefits of standardization of data elements for EHRs and EMRs include improved quality of care and access to care, increased productivity, and facilitation of outcomes monitoring, benchmarking and performance measurement. 8,13 EHRs supported by defined, coded data elements also enable EHR system interoperability.…”

“…Electronic health records (EHRs) are increasingly prevalent, particularly in primary care, and represent a novel opportunity to integrate guidelines into day-to-day practice. 8 Recognizing the need for electronic medical records (EMRs), the Government of Ontario funded a pilot project to determine the ability to incorporate asthma data elements from the The Lung Association -Ontario's (TLA's) Asthma Care Map (ACM) (a paper form used for clinical documentation in Ontario's Primary Care Asthma Program sites) into an electronic format, and to send deidentified data to a central server for analysis and report generation. Cross-referencing of the ACM data elements to SNOMED V R (Systemized Nomenclature for Medical Clinical Terms) and LOINC V R (Logistical Observation Identifier Names and Codes) revealed a high level of congruency (100% of laboratory variables and the majority of clinical variables were exact [47.8%] or partial [17.8%] matches).…”

“…6 Recognizing that EHR data standards are of national relevance, the Canadian Thoracic Society (CTS), in collaboration with TLA, launched a Pan-Canadian REspiratory STandards INitiative for Electronic Health Records (PRESTINE) initiative. 8 Stakeholders attended a national workshop in October 2011 to develop a strategy to recommend respiratory data elements and standards for use in electronic medical records across Canada that meet the needs of providers, administrators, researchers and policy makers, in order to facilitate evidence-based clinical care, monitoring, surveillance, benchmarking and policy development. Workshop attendees recommended the project focus initially on asthma and related data elements for COPD, smoking history and pulmonary function elements that are applicable to many respiratory conditions.…”

Asthma education: an essential component in asthma management

“…Physicians are considered the best to persuade patients about the need to improve their knowledge and skills, while motivational interviews, easy access to trained educators and peer influence can address patients' barriers to participation in educational programmes. Furthermore, various means to help clinicians consider and promote education to patients, such as paper, stamps or electronic reminders of current recommendations, and availability of educators at the site of practice, can improve the delivery of those interventions [24][25][26]. In one of our recent reports, offering educational services through an experienced educator who attended family medicine clinics resulted in a significant reduction in unscheduled physician visits and more appropriate medication use, as well as increased provision of an action plan [25].…”