As recent data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) Survey has made clear, the prevalence of spirometry testing is still relatively low in some regions of the U.S., especially considering the rising global rates of COPD. A contributing factor to these results, however, could simply be that spirometry data is too frequently not transmitted into electronic medical records (EMRs).
Exclusion of this data from EMRs skews the image of asthma and COPD control, making it appear as though exacerbation risk is lower than it really is. It impairs accurate measurement of performance and patient outcomes and inhibits communication not only between facilities, but also between members of multi-disciplinary teams. Especially among patients taking regular medication for COPD or asthma, spirometry data should always be integrated with EMRs to ensure the best care. Available spirometry data also can provide insight into physician prescribing among COPD patients and help with the development of evidence-based guidelines for patient care.
A 2006 study to assess physician prescribing of bronchodilators and inhaled corticosteroids for patients with COPD drew upon an EMR research database to determine disease severity. However, a lack of available spirometry data made it difficult to accurately evaluate whether certain treatments were appropriate against contemporary guidelines. According to the study, “less than 1% of COPD patients in the database had spirometry data available, indicating either a lack of [pulmonary function testing] in primary care, lack of documentation, or limited transmission of spirometry data into the EMR.” This dearth of data inhibits development of evidence-based guidelines.
A more recent study attempted to compare asthma control measurements set by the Canadian Thoracic Society Asthma Management Consensus Summary (CTS) and the Global Initiative for Asthma (GINA) guidelines, again using EMRs from two primary care institutions. The percentage of patients whose asthma was reported as completely controlled was higher for those who had no recorded spirometry data. The number sat at 22.1% for those with CTS symptoms only, but fell to 9.7% for those with CTS symptoms plus spirometry testing. Similarly, following GINA guidelines, 17.7% of patients with no spirometry reportedly had completely controlled asthma, but this was true for only 14.1% of those with spirometry data. The differences suggest that a lack of spirometry testing–or at least of known spirometry data–leads to an overestimation of asthma control. The study concluded that “differences in the spirometry criterion threshold are primarily responsible for this discordance. Failure to include spirometry as part of the control index consistently overestimates asthma control and may underestimate future risk of exacerbations”.
Data from the 2011 BRFSS Survey, which included a COPD module for the first time, revealed that prevalence and healthcare utilization in the forms of both testing and treatment varied widely by state. While 81.2% of COPD respondents in Nevada reported having a diagnostic breathing test, only 57.3% of respondents in Peurto Rico could say the same. While these numbers certainly have improved over the last several years, judging by previous studies, the variance indicates there’s more work to do. Ensuring that spirometry data is transferred to EMRs will not only help ensure accurate reports, but allow researchers to pinpoint areas where testing should be made more widely available.
Another benefit of consistently including spirometry data in EMRs is facilitation of communication between in-patient and out-patient treatment centers and within multi-disciplinary care teams. A 2010 review found that an integrated care program consisting of a community-based outreach nurse, allied health staff, rehab services, and a case manager can identify gaps in care and improve quality of life for COPD patients. With such a varied team, a thorough EMR is necessary to ensure agreement on disease severity and the best course for treatment.
Luckily, these and other studies examining the usefulness of updated EMRs to healthcare management have gotten the attention of the medical device industry. Now, several options exist for easy data transmission from spirometer to EMR.
Computer-based spirometers, for example, automatically interface with a PC, and generally have more capabilities than independent spirometers, which use microprocessors. EMR interfaces vary by manufacturer, but they must be compatible with Health Level 7, the industry standard protocol for medical data transmission. The spirometer’s database can then be set up to transmit information to the EMR.
However, non-computer-based spirometers are smaller, lighter, more portable, and can easily connect to an EMR if the proper download capabilities and computer software are purchased. Often the data can be transmitted via a USB stick. The danger here, of course, is that the USB could potentially be lost or stolen, which would constitute a breach of the HIPAA Privacy Rule. A safer option would be an independent spirometer capable of sending the data remotely. Encrypting data also protects it from misuse by unintended recipients.
More and more health practices are adopting EMRs as a way to reduce costs, deliver better care, and more accurately measure performance outcomes. Since COPD has taken precedence as a leading cause of death in the U.S., integrating spirometry data into these records is necessary to draw a clearer picture of the disease and determine guidelines for best practices going forward.
- “Chronic Obstructive Pulmonary Disease Among Adults – United States, 2011” Morbidity and Mortality Weekly Report. November 23, 2012; 61(46):938-9432.
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- Dostaler SM, Olajos-Clow JG, Sands TW, Licskai CJ, Minard JP, and Lougheed MD. Comparison of Asthma Control Criteria: Importance of Spirometry. Journal of Asthma. December 2011; 48(10):1069-1075 .
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- Electronic Medical Records (EMR). Resources. White Cardio Pulmonary, Inc. http://www.whitecardiopulmonary.com/emr.html
- Xu J, Kochanek KD, Murphy SL, and Tejada-Vera B. Deaths: Final Data for 2007. National Vital Statistics Reports. May 20, 2010; 58(19).
Katie Siegel is on staff at ADVANCE. Contact: email@example.com