By Dr. Steve Arendt

It happens every year during March. Even people who don’t follow college basketball suddenly get caught up in filling out their brackets, trying desperately to figure out who will come out on top so they can claim bragging rights (and often a nifty cash prize).

While there are those who just sort of randomly choose teams so they can be part of the action — not a bad strategy if there are a lot of upsets — many others spend an inordinate amount of time poring through the latest statistics and analyses trying to gain an edge. But what if, instead of using up-to-the-minute stats, they decided to use last year’s information, figuring it would be close enough? It’s a pretty good bet that the information would be of little value to them.



Yet, that is the situation in which hospitals and health systems often find themselves when it comes to evidence-based content. When it was first implemented, all of that content was likely spot-on. But just like college basketball rosters, the evidence in medicine is constantly evolving. Hospitals and health systems are typically a year or more behind in reviewing their content, which means at least some of the information being delivered to the point of care through the electronic health records (EHR) is going to be outdated. This is bad, because, as Anne Bobb has said, “When order sets are … inadequately maintained, they become templates for efficiently practicing outdated medicine on a widespread basis.” The hard part is determining which pieces of content need to change.

The usual process for updating content is either for physicians to attempt to manually review the content against current evidence-based sources, or to completely replace the current content with new. Neither approach is ideal. Manual review of all the current content is a virtually impossible task due to the time and resources required. So it tends to occur on more of a rolling cycle that can make the first-reviewed content even more outdated by the time it comes up again. That approach also tends to lead to spending time reviewing content that really doesn’t need updating.

Conversely, replacing all the content with new in a “full-court press” is a very tough sell, especially given the investment of time, money and resources that were required to bring the content to its current state. A better approach is to define the conditions where the evidence changes the most rapidly — those that are generally high-volume, high-risk or high-cost — across all disciplines and venues. Technology can then be leveraged to automatically compare the interventions for those conditions to the latest evidence-based recommendations, enabling you to focus your organization’s attention where the needs are most immediate.

Going this route enables you to build on the hard work your organization has already put into the content system — just like basketball fans supplementing their knowledge base with the latest injury reports — ensuring you’re providing your patients with the best care possible, all while delivering the best financial outcomes for everyone.

Creating teamwork
Once potential areas of change have been discovered and recommendations made, it is critical to seek the input of the people who will ultimately be responsible for its use — your physicians. It’s rare that any physician, especially those with years of experience, likes being “told” how he or she must practice medicine, so gaining input and consensus is critical. Although evidence-based standardization of treatment is typically a good thing, it tends to work better when all the physicians have a say in developing those standards.

Establishing an asynchronous communications system can help expedite this process. This type of system will alert physicians via email that a change has been proposed, and provide a link to an entry showing what is being recommended and why. Good systems will even highlight whether it’s a care/ quality-based change, regulatory change or the result of some other need. Once physicians follow the link, they should be able to easily review the evidence (which gives context to the decision), approve or disagree with the change and provide any comments, all within the same system.

If the decision is made to proceed, the organization can make the update, which appears in the EHR immediately. This process ensures physicians are working with the best evidence-based information while still leaving leeway for physicians to use their clinical judgment to make care decisions based on the individual patient’s characteristics. Ultimately, obtaining consensus and collaboration makes the lift to standardization much easier to achieve, which helps elevate quality while driving down the cost of care, which, of course, are two of the pillars required to transition to value-based care.

About the author: Steve Arendt, M.D., is a board-certified family physician and senior director clinical leadership at Zynx Health.