Group Homework # 3 How may treatment be better standardized for common conditions? MMI-402 Summer 2010 Group #1 Jacob Frimpong John Goss Kempton Presley Thanh Tu Tran

Agenda 3/20/ How may treatment be better standardized for common conditions? 2 areas of focus CPGs- Clinical Practice guidelines IT Perspective -potential areas of focus

3/20/ "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." (Field & Lohr page 38). CPG - Definition

3/20/ CPG Design The first step is the generation of the paper guidelines at authoring institutions The second step is the translation of the paper guidelines into an algorithmic form to be easily used by physicians The third step is to translate the paper-based guideline into computer-based presentations The fourth step is the implementation of the computer-based presentations in clinical institutions The fifth and final step is the end user’s interpretation of the guideline as it is represented in the guideline applications in specific clinical settings.

3/20/ CPGs – Useful? Still a need for strategies that will prompt physicians to change their prescribing practice in accordance with the expert recommendations. Preferably, strategies should be investigated that have proved successful at altering physician behavior in other settings. According to the CMAJ News in January 2010, the value of medical practice guidelines has been questioned- polypharmacy – due to chronic conditions Loss of physician autonomy

3/20/ IT Point of view The scalability of tried and true clinical best practices into the delivery system afforded by computerized decision support systems could yield tremendous quality benefits for the healthcare system. From a quality standpoint, standardization has been touted as a antidote to many of the medical errors exposed in the 1999 Institute of Medicine report To Err Is Human: Building a Safer Health System.

3/20/ Examples of focus areas Automated Drug ordering/dispensing – reduction in malpractice claims Evaluation of impact of the guidelines – to identify needed guideline revisions in response to unanticipated system barriers, and to serve as evidence to providers that the process has an effect. Adoption of physician scorecards – the use of performance feedback to providers with peer comparison will lead persistent changes in provider behavior. Electronic Data Systems – in addition to storing information about patients, EMR/EHR systems will increase access to and awareness of disease-specific guidelines by directing the provider to a comprehensive library. Leadership Support – high-level departmental support with dedicated personnel Relevant data -Increased emphasis on reporting and use of up to date information

3/20/ Examples of focus areas-cont’d Use of web based profiler tools within specialty care areas allows providers to standardize treatment regimens across their practice and to evaluate costs Can help break ties between two clinically equivalent treatments Can help provide communication of value to providers Less confusion with nursing Less confusion with billing Payers need consistency of care – it will help with premiums as well.

3/20/ Questions

References Biomedical Informatics: Computer applications in Healthcare and Biomedicine Series, Edward H. Shortliffe, Health Informatics, The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers?The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers?, Stephen J. Genuis, JABFM, March Value of medical practice guidelines questionedValue of medical practice guidelines questioned, CAM J News, January 21, 2010 Wright, S. W., Trott, A., Lindsell, C. J., Smith, C., & Gibler, W. B. (2008). Creating a System to Facilitate Translation of Evidence Into Standardized Clinical Practice: A Preliminary Report. [Electronic version]. Annals of Emergency Medicine, 51, Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program, Institute of Medicine, Washington, DC: National Academy Press, lowering-cost-clarifying-communicationhttp:// lowering-cost-clarifying-communication - Daniel Denver