1. EBM practice Net - Belgium Stijn Van de Velde Robert Vander Stichele Siegfried Geens

2. EBM practice NET: a collaborative effort  Non profit organisation  Open to Belgian organisations that produce EBM  Funding: – Reimbursement organisation (National Institute for Health and Disability Insurance, INAMI-RIZIV) – Started in 2011  4 Member groups: – Government – Producers – Disseminators – Users  Founding members CEBAM E-Health BCFI DOMUS MEDICAKCE FOD DG 1,2 FARMAKA MINERVA VIRTUAL LIBRARY SSMG WVVK WVVV EBMpracticeNet 2

3. AIM of the EBM practice Net  To optimise quality of care and efficiency by providing all Belgian healthcare professionals free access to: 1) An up to date database of selected Belgian and international guidelines (GL) 2) Belgian EBM information (other than GL) 3) An electronic clinical decision support system  Primary focus: GP’s  Also muldisciplinary focus for allied health personnel and specialists 3EBMpracticeNet

4. Database of guidelines  Working principle: To be user-friendly the database should provide GL in 80-90% of diagnosis – Number of Belgian GL too limited  need for large amount of foreign GL  foreign GL need to be adapted  searching for every missing topic the best foreign GL = not feasible – Topics without Belgian GL:  purchase 1 foreign GL database (with intention to adapt) 4EBMpracticeNet

5. Search for a comprehensive database of guidelines  Main candidates: CKS (UK) en EBM Guidelines (Finland Duodecim). – Study Italian Cochrane Centre: Banzi R, Liberati A, Moschetti I, Tagliabue L, Moja L. A review of online evidence-based practice point-of-care information summary providers. J Med Internet Res. 2010; 12(3):e26. EBM Guidelines (Finland Duodecim) – Internal evaluation: 1) EB methodology / Editorial quality 2) Coverage 3) Possibility to link with EPR 4) Adaptability 5) Cost 5EBMpracticeNet

6. Search engine (ICPC, ICD, MeSH) User query analysis and routing Belgian GL summaries Belgian EBM information Finnish GL Summaries Finnish EBM- Scripts Digital Library Specific/general user query User authorisation Access rights management EBMpracticeNet External EBM websites Computerised order with decision support system Infostructure 6EBMpracticeNet

7. Point of care Structured patient data from EPRs EBMeDS system Reminders, therapeutic suggestions, diagnosis- specific links to GL EBM-scripts  Principle:  structured patient data from EPRs  EBMeDS system  ESystem returns reminders, therapeutic suggestions and diagnosis-specific links to guidelines. 7EBMpracticeNet

8. EBM-scripts  Evaluation of sample of scripts (by Domus Medica, CAMG, UCL) – Key question: Can existing scripts be directly applied to Belgian setting? – Methods: Identification + analysis of scripts (www.ebmeds.org) for which GL Domus Medica was availablewww.ebmeds.org In depth analysis of sample of 10 scripts 8EBMpracticeNet

9. EBM-scripts EBMpracticeNet9  Results: Total nb of scripts n=187 Scripts without DM GL n=148 Scripts with DM GL n=39 -Agreement n=16 -Minor disagreement n=18 -Major disagreement n=5

10. EBM-scripts  In depth analysis of 10 scripts with disagreements – Same main references  different recommendation because of contextual factors (eg. Obesity) – Same references  different interpretation (eg. Hypertension, Diabetes type 2) – Different references because of lack in updating  different recommendation (eg. Hypertension, Antibioticprophylaxis for bites, Obesity) 10EBMpracticeNet

11. EBM Scripts - conclusions  Workflow required for evaluation/adaptation/validation of scripts ( and GL) – Substantial amount of work – Risk of alert fatigue  Careful selection of most important scripts More reminders Less attention 11EBMpracticeNet

12. Project leader Editor-in-Chief Secretariat User query manager Search path designers Guideline abstracters Indexers Program- mers Functional analysts Organigram Technical staff Redaction 12EBMpracticeNet

13. Next steps  Phase 1: – Selection of priority topics – Definition of work processes – Restructuring Belgian GL to standard template – Linking to Belgian EBM information – Access to GL Duodecim with warning that information is not adapted – Translation of GL Duodecim (  see presentation by technical partner IVS)  Phase II: – Adaption of priority GL for wich no Belgian GL are available – Adaptation of selected EBM scripts  Continuous – Update of information 13EBMpracticeNet

14. Impact evaluation  Collection of data and quality indicators by Ambulatory Care Health Information Lab – ACHIL  Development of research protocol to evaluate impact on the quality of care 14EBMpracticeNet