Secondary use of EMR for residency training in asthma care and documentation

PROJECT SUMMARY Asthma is the most common chronic illness among children. In our preliminary study, we discovered significant variations in the volume and quality of clinical documentation on asthma in electronic medical records (EMRs) between pediatric residents and pediatric faculty. For example, although pediatric residents documented much more extensively than the pediatric faculty on asthma-related histories consistent with a diagnosis of asthma, the residents were less likely to make an actual diagnosis of asthma than their faculty counterparts. This variation in documenting asthma-related events in EMRs has two important implications: one is a proficiency issue related to the training of pediatric residents in achieving clinical competence in asthma care and documentation; the other is a data quality issue, which impacts the secondary use of EMR for downstream analyses. At present, little has been reported on the secondary use of EMR for residency training. The primary goal of this proposed study is to develop an informatics tool assessing residents' adherence to asthma guidelines (i.e., competence in asthma care) and documentation variation (i.e., competence in documentation) (Aim 1) and evaluate individual pediatric resident's competence in asthma care and documentation by conducting a population-based birth cohort study (Aim 2). The tool can be utilized to provide ?individualized clinical effectiveness data? for residents enhancing their clinical competence in asthma care, as recommended by the Accreditation Council of Graduate Medical Education (ACGME). In Aim 1: We will develop an automated informatics tool assessing adherence to asthma guidelines and documentation variation in primary care settings. We will extract the necessary clinical elements from both structured data querying from our database and unstructured data using natural language processing (NLP) techniques to assess adherence to guidelines and documentation variation. The performance of element extraction will be assessed against manual chart reviews as gold standard. In Aim 2: We will evaluate clinical competence of pediatric residents in asthma care and asthma diagnosis. We will assess clinical competence in asthma care for children with persistent asthma and examine clinical competence in asthma diagnosis from clinical documentation using the informatics tool developed in Aim 1. Expected outcomes: The proposed research is significant, innovative, and exploratory as little is known about the secondary use of EMR for residency training. If successful, the study results will: a) deliver individualized clinical effectiveness data report to pediatric residents to enhance their clinical training and documentation; and b) provide an informatics tool assessing adherence to asthma care guidelines in clinical practice settings.