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S107– Embedding guidance into electronic medical records and panel management tools: Implications for guideline writers
Oral Presentation
S107– Embedding guidance into electronic medical records and panel management tools: Implications for guideline writers Wiley Chan, MD (Presenter) (Kaiser Permanente, Portland, Oregon); Craig Robbins, MD (Kaiser Permanente, Denver, Colorado) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Incorporating guidelines into health-care systems BACKGROUND (INTRODUCTION): Guidelines are largely academic exercises unless the guidance is implemented in health-care delivery systems. The specific methods of embedding guidance into electronic health records and panel management tools have implications for guideline writers. LEARNING OBJECTIVES (TRAINING GOALS): 1. Understand how guidance is embedded at the point of care. 2. Discus how guidelines can be written to better enable electronic implementations. METHODS: We will explore the various mechanisms Kaiser Permanente uses to embed guidance at the point of care to illustrate how guideline writers can tailor their documents to support electronic implementations. We will also explore elements that make electronic implementations successful. RESULTS: An example of how to embed guidelines is through the use of web portals. Kaiser Permanente has worked to develop portals for guidelines that address the needs of clinical users. Such portals can serve as an entry point into the larger guideline document by posting hyperlinks to background information around specific recommendations. DISCUSSION (CONCLUSION): We will discuss all of the ways Kaiser Permanente supports guideline implementation into electronic medical records by embedding guidance in the EMR and Panel Management tools and by distilling key sought-after guidance into a concise interface. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products
S108– Implementation of the Guidelines for the Diagnosis and Management of Asthma, 2007 (Guidelines) in Suffolk County, New York, operated health centers (SCHCs) Lewis R. Mooney (Presenter) (Suffolk County (NY) Dept. of Health Services, Coram, New York); Shaheda Iftikhar, MD (Suffolk County (NY) Dept. of Health Services, Hauppauge, New York); Karen Kessler, RN (Suffolk County (NY) Dept. of Health Services, Coram, New York) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Incorporating guidelines into health-care systems
69 BACKGROUND (INTRODUCTION): In order to improve asthma care for the 6132 persons with asthma seen yearly at the ten (10) SCHCs, a broad-based asthma taskforce (AT) of end users was formed to develop policy and implementation tools based on the Guidelines. Compliance was tracked by a departmental asthma coordinator using one of the implementation tools. LEARNING OBJECTIVES (TRAINING GOALS): 1. Designing effective implementation tools for guideline implementation. 2. Overcoming barriers to the implementation of complex national guidelines at the local level. METHODS: The AT developed local policy, procedure, and implementation tools adapted from the Guidelines. These implementation tools consisted of: six age-specific Provider Education Summary Sheets - Classifying Asthma Severity/Classifying Asthma Level of Control; three age-appropriate Asthma Medication Worksheets; an Asthma Action Plan (AAP) in English and Spanish; and an Asthma Management Plan (AMP), which is a single-page patient encounter form that generated a carbonless second page and enables the health-care professional to implement departmental asthma policy on a single page. After deployment, asthma education sessions were held. Monthly compliance with the policy was ensured by the full-time asthma coordinator using the carbonless yellow copy of the AMPs to track compliance. Compliance was reported both monthly at departmental meetings and on the department’s intranet web site. RESULTS: In January 2009, the first month of deployment, 231/458 persons (50%) with asthma had AMPs on their medical record. This increased to 428/476 (90%) by December 2009. For the initial project year 5229/6132 persons (85%) with asthma had AMPs on their medical records. DISCUSSION (CONCLUSION): Successful implementation of new and complex national clinical guidelines in a large and diverse health-care delivery system is facilitated by broad input into policy design, design of appropriate implementation tools, selecting methods of policy deployment, education, and the on-going data collection and dissemination. These components are required to bring meaningful change to large and complex health-care delivery systems. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Medical providers and executives
S109– Rationalized perioperative antibiotic prophylaxis through incorporation of Scottish Intercollegiate Guideline Network (SIGN) guidelines with local practice Wendy L. Craig, MPH (Presenter) (Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom); Roberta James, PhD (SIGN, Edinburgh, Scotland, United Kingdom); Terry O’Kelly, MD (Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom)
S107– Embedding guidance into electronic medical records and panel management tools: Implications for guideline writers Wiley Chan, MD (Presenter) (Kaiser Permanente, Portland, Oregon); Craig Robbins, MD (Kaiser Permanente, Denver, Colorado) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Incorporating guidelines into health-care systems BACKGROUND (INTRODUCTION): Guidelines are largely academic exercises unless the guidance is implemented in health-care delivery systems. The specific methods of embedding guidance into electronic health records and panel management tools have implications for guideline writers. LEARNING OBJECTIVES (TRAINING GOALS): 1. Understand how guidance is embedded at the point of care. 2. Discus how guidelines can be written to better enable electronic implementations. METHODS: We will explore the various mechanisms Kaiser Permanente uses to embed guidance at the point of care to illustrate how guideline writers can tailor their documents to support electronic implementations. We will also explore elements that make electronic implementations successful. RESULTS: An example of how to embed guidelines is through the use of web portals. Kaiser Permanente has worked to develop portals for guidelines that address the needs of clinical users. Such portals can serve as an entry point into the larger guideline document by posting hyperlinks to background information around specific recommendations. DISCUSSION (CONCLUSION): We will discuss all of the ways Kaiser Permanente supports guideline implementation into electronic medical records by embedding guidance in the EMR and Panel Management tools and by distilling key sought-after guidance into a concise interface. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products
S108– Implementation of the Guidelines for the Diagnosis and Management of Asthma, 2007 (Guidelines) in Suffolk County, New York, operated health centers (SCHCs) Lewis R. Mooney (Presenter) (Suffolk County (NY) Dept. of Health Services, Coram, New York); Shaheda Iftikhar, MD (Suffolk County (NY) Dept. of Health Services, Hauppauge, New York); Karen Kessler, RN (Suffolk County (NY) Dept. of Health Services, Coram, New York) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Incorporating guidelines into health-care systems
69 BACKGROUND (INTRODUCTION): In order to improve asthma care for the 6132 persons with asthma seen yearly at the ten (10) SCHCs, a broad-based asthma taskforce (AT) of end users was formed to develop policy and implementation tools based on the Guidelines. Compliance was tracked by a departmental asthma coordinator using one of the implementation tools. LEARNING OBJECTIVES (TRAINING GOALS): 1. Designing effective implementation tools for guideline implementation. 2. Overcoming barriers to the implementation of complex national guidelines at the local level. METHODS: The AT developed local policy, procedure, and implementation tools adapted from the Guidelines. These implementation tools consisted of: six age-specific Provider Education Summary Sheets - Classifying Asthma Severity/Classifying Asthma Level of Control; three age-appropriate Asthma Medication Worksheets; an Asthma Action Plan (AAP) in English and Spanish; and an Asthma Management Plan (AMP), which is a single-page patient encounter form that generated a carbonless second page and enables the health-care professional to implement departmental asthma policy on a single page. After deployment, asthma education sessions were held. Monthly compliance with the policy was ensured by the full-time asthma coordinator using the carbonless yellow copy of the AMPs to track compliance. Compliance was reported both monthly at departmental meetings and on the department’s intranet web site. RESULTS: In January 2009, the first month of deployment, 231/458 persons (50%) with asthma had AMPs on their medical record. This increased to 428/476 (90%) by December 2009. For the initial project year 5229/6132 persons (85%) with asthma had AMPs on their medical records. DISCUSSION (CONCLUSION): Successful implementation of new and complex national clinical guidelines in a large and diverse health-care delivery system is facilitated by broad input into policy design, design of appropriate implementation tools, selecting methods of policy deployment, education, and the on-going data collection and dissemination. These components are required to bring meaningful change to large and complex health-care delivery systems. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Medical providers and executives
S109– Rationalized perioperative antibiotic prophylaxis through incorporation of Scottish Intercollegiate Guideline Network (SIGN) guidelines with local practice Wendy L. Craig, MPH (Presenter) (Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom); Roberta James, PhD (SIGN, Edinburgh, Scotland, United Kingdom); Terry O’Kelly, MD (Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom)