THE JOHNS HOPKINS ANTIBIOTICS GUIDE

QUESTIONS AND ANSWERS

April 2001

1. What is the Johns Hopkins Antibiotics Guide (ABX Guide?)

The ABX Guide is an electronic reference tool that gives doctors continually updated and easily accessible digests of the most current expert opinions and guidelines for the diagnosis and treatment of infectious diseases. The Guide is accessible on the Internet or with pocket computers (personal device assistants, PDA) using Windows PocketPC and other operating systems). This versatile means of presenting information will let the guide be accessible in hardcopy (a forthcoming paper version) and with new technologies (e.g., smart phones/pagers, clipboard-style mobile computers).

2. What is the mission of the ABX Guide?

The primary mission of the ABX Guide is to improve the delivery of infectious disease care by bringing current, evidence-based medicine to the point of care. Our approach is to develop and maintain an environment in which experts share their opinions on the diagnosis and treatment of infectious diseases in an easily accessible format. The ABX Guide covers a variety of issues, including appropriate use of antibiotics, antibiotic resistance, correct dosing of drugs, and drug costs.

The secondary mission is to identify patterns of antibiotic use among doctors, specifically those patterns that show whether physicians adhere to established guidelines for using antibiotics and the impact on outcomes. This research will provide valuable insight into the factors that influence and predict antibiotic selection by frontline practitioners. A wealth of unrecognized clinical expertise exists in the community that will formally contribute to the advancement of medical knowledge.

3. What is evidence-based medicine?

Evidence-based medicine is the practice of medicine using the best medical evidence to design a specific treatment for a particular patient. It combines the skills and judgment that individual clinicians gain through daily experience with research evidence that identifies the best and safest diagnostic tests and treatments.

4. Why was the ABX Guide developed?

All clinicians need up-to-date information about antibiotics and access to current guidelines and expert opinion about the use of these drugs. Unfortunately, the amount of such information accumulates faster and in greater quantities than most physicians can make use of effectively. Thus, new information that could help patients is often not used.

In an attempt to cope with the flood of new information, most physicians, regardless of their specialties, carry two standard pocket references, a pharmacopoeia (standard reference book listing all drugs and their proper use) and an antibiotic manual.

The ABX Guide is designed to help physicians more efficiently manage the information overload posed by the relentless stream of new information that quickly renders printed references outdated.

5. Why is the ABX Guide designed specifically for use at the point of patient care?

The ABX Guide is designed specifically for point of care use in order to provide physicians pertinent, up-to-date information at the time and in the setting that they make diagnoses and determine treatments. Most physicians carry in their white lab coats small paperback antibiotics guides that they routinely consult at the point of care. In addition, there are many Internet-based references for physicians. However, the mobile ABX Guide can be carried in a pocket like a book, while offering a regularly updateable source of information, as can be found on a website.

Design and Content

6. How does the ABX Guide work?

The ABX Guide is written and organized to be useful to physicians at all levels of expertise and in all specialties. Users can access information in three main categories: Diagnosis/Syndrome, Clinically Relevant Pathogens and Specific Antibiotics. The guide gives the user basic information first; but users have the option of navigating through the database to get more in-depth information. ABX Guide experts review all relevant literature and summarize it into concise bullet points. The ABX Guide provides diagnosis and treatment options based on expert opinions. This leaves the final treatment decisions to the physician, rather than compel the practice of "cookbook" medicine.

7. Who authors the material in the ABX Guide?

A team of leading and trusted experts in infectious diseases, both Hopkins faculty and external authorities, writes the content presented in the ABX Guide. Dr. John G. Bartlett, world-renowned infectious disease expert and chief of the Division of Infectious Diseases at Hopkins, serves as editor-in-chief of the ABX Guide. The curriculum vitae of all authors and reviewers are available on the website. Material contained in the ABX Guide is clearly attributed to the individual authors.

8. How is the material entered and edited?

Authors responsible for specific topic areas can write and edit their material from any Internet-connected terminal by logging onto their personal secure website with a password. Before going "live", the new material is routed by an administrator to a second expert for review. This electronic authoring and review process expedites the process of disseminating important changes in the appropriate evaluation and treatment of disease, while ensuring all information is relevant and accurate.

9. How does the review system work?

Review of written material occurs in four steps: 1. basic editing; 2. peer review; 3. cross-specialty review, as appropriate; 4. review by a member of the senior advisory board of ID thought leaders.

10. How often is the content updated?

Content authors are required to update their materials at least monthly. However, they will immediately add information from publications, conference, new guidelines or other sources that significantly alter the relevance or accuracy of their section of the guide.

Developing Organization

11. Who created the ABX Guide?

Sharon McAvinue, Director of Hopkins POC-IT, Division of Infectious Diseases, conceived and guided the development of the ABX Guide based on her internet experience over the past five years. Having recognized that physicians do not use the Internet to read volumes of medical information, she initiated a project to develop a point-of-care antibiotic reference. Dr. Walt Atha, an emergency physician at Hopkins, created the structure and oversees both the creation of the contents and maintenance of the ABX Guide. He now serves as Director of the ABX Guide.

12. What is Hopkins POC-IT?

Hopkins POC-IT ("Information Technology at the Point of Care") is a program that creates point-of-care medical guides for doctors. The goal is to offer physicians the ability to consult expert opinions and up-to-date treatment guidelines. Hopkins POC-IT evolved from work done on the ABX Guide by Sharon McAvinue and Walter Atha in the Division of Infectious Diseases. For historical reasons Hopkins POC-IT is housed in this Division, although future "POC-IT Guides" will encompass other areas of medicine. The offices of Hopkins POC-IT are located in the Lighthouse Point office space in Baltimore, along with other programs in Infectious Diseases.

13. What is the advantage of an academic medical center developing such a guide?

The ABX Guide is free of the marketplace pressures that commercial efforts face. Some commercial ventures focus on eliminating medication errors caused by poor penmanship while the ABX Guide addresses an equally (if not more) significant issue: correct use of the drugs prescribed. Content undergoes a strict peer review process, meeting academic standards. The ABX Guide provides a gold standard for such tools.

14. Will there be similar Guides forthcoming?

Yes, the applications that comprise the ABX Guide program can readily present information about other medical areas. For example, the Division of Infectious Diseases, a recognized leader in the field of HIV/AIDS has begun work on production of an HIV Guide for the primary management of HIV infection.

Application Development

15. Who developed the software applications?

External vendors developed the applications for viewing and presenting the ABX Guide: Microsoft Corporation (Redmond, WA), Applied Theory (Syracuse, NY), and GroundZero (New York, NY). MCS-AT (Microsoft Consulting Service - Advanced Team) created the Windows CE-based PocketPC version of the Guide. Applied Theory developed the core database structure, the administrative functions, and the interfaces for transferring data to/from the PDA applications. GroundZero designed the web version layout.

Funding

16. How is Hopkins POC-IT funded?

The program was developed using unrestricted educational grants from pharmaceutical corporations (Abbott Laboratories, Bristol-Myers Squibb, Merck & Co., Ortho-McNeill, Pfizer, Pharmacia, and Roche). Sponsors are acknowledged in a special section on the website, but no banner or commercial advertising exists in any of the applications.

17. What does the pharmaceutical industry receive for its support of Hopkins POC-IT?

The website credits sponsoring pharmaceutical corporations for their contribution to this national educational effort. Hyperlinks to corporate websites are also made available. These companies can use their field forces to distribute marketing materials about the ABX Guide, a mutually beneficial arrangement, promoting the Guide as well as adding value to the face-to-face encounters between physicians and company representatives.

Data Collection and Use

18. What kind of data will the ABX Guide collect?

Hopkins will anonymously collect both demographic information (e.g., location of the physician’s practice and specialty), as well as what information the doctor sought from the ABX Guide. Visitors to the website are required to complete a brief questionnaire consisting of five demographic questions to gain access to the database. The user must establish a unique username and password to access the site. Unless a user chooses to voluntarily submit an e-mail address, responses can in no way be linked back to any individual. Information collected about user navigation through the site is combined with responses to this questionnaire to obtain information on trends of antibiotics use. Users who wish to access the clinician question and answer forum on the website must complete a questionnaire with more in-depth clinical questions

19. What are Hopkins’ plans for use of the data?

Hopkins is primarily interested in the data for healthcare research and subsequent scholarly publications. Several studies are being planned and others are under review to evaluate the impact of point-of-care applications on medical care. A Hopkins oversight committee is being formed to consider the potential uses of aggregate data, both academically and commercially.

20. How can the security and anonymity of data be assured?

The applications that make up the ABX Guide do not have a method for collection of information that could identify an individual. Once collected, the data is transferred from the website to the data center at Hopkins POC-IT via encrypted transmission to ensure security.

21. Who will analyze the data?

A data center within the Hopkins POC-IT program will analyze the data. Specifically, Hopkins faculty with expertise in epidemiology and statistics will evaluate the data for important trends in prescribing patterns. An Advisory Board must approve all requests for data or reports.