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New Decision Support Tool Places Key Information Front and Center

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New Decision Support Tool Places Key Information Front and Center

New Decision Support Tool Places Key Information Front and Center
Karen Nitkin

Date: 11/02/2018

When a patient comes to The Johns Hopkins Hospital’s emergency department with a bat bite, clinicians no longer have to search for the correct rabies vaccine regimen, or tailored patient instructions on how to complete the complex regimen. And they don’t need to find out how to contact local animal control.

The information is now available in a clinical decision application called EB-Guidelines, developed by Johns Hopkins clinicians to promote best practices across the health system.

EB-Guidelines (EB for evidence-based) works in AgileMD, a platform that enables medical providers to build their own guidelines in the Epic electronic medical records system and include institution-specific information.

The effort began in the Johns Hopkins emergency department, led by Mustapha Saheed, the emergency department’s medical director.

So far, he says, Johns Hopkins experts have created about 65 evidence-based emergency care guidelines.  

“If there are key tools needed, like clinical calculators, we’ve built those in,” he says. “If there are forms we need, we build those in. Clinicians also see all sorts of things that are value-added, like links to medication order sets, critical images, consultation guides and tailored patient instructions. The list continues to expand — we can now also embed short videos where appropriate.”

The guidelines are being rolled out to emergency departments at Johns Hopkins Bayview Medical Center and Howard County General Hospital.

And that’s just the beginning.

“We want to integrate AgileMD into every patient care setting,” says Pamela Johnson, physician lead for the Health System High Value Care Committee, “to standardize decision-making about tests and treatments according to evidence in the literature in conjunction with our physicians consensus about best practice.”

In particular, she is leading development of AgileMD guidance for appropriate use of advanced diagnostic imaging, noting that a Centers for Medicare & Medicaid Services (CMS) rule going into effect in January 2020 requires use of a clinical decision support tool for ordering computed tomography (CT) scans, MRI scans and nuclear imaging.  

“We want to have perfect practice, where we’re not under-ordering and we’re not over-ordering diagnostic tests,” Johnson says.

The Johns Hopkins-led High Value Practice Academic Alliance has won approval from CMS to write evidence-based guidance for ordering advanced diagnostic tools for suspected or diagnosed coronary artery disease; suspected pulmonary embolism; headaches; hip, lower back, shoulder, cervical or neck pain; and suspected or diagnosed lung cancer.

While other health systems have begun using AgileMD for decision-support guidance, Johns Hopkins appears to be the only organization building out guidelines systemwide and across disciplines, says Saheed.

The goal, he says, is to promote best-practice decision-making by giving clinicians seamless access to the information and documents they need.

“When we looked at clinical practice, we saw significant variability and we started to ask why,” he says.  

“Some of it is simply because the literature is changing constantly. But often it’s because of the increasing complexity of care, which makes it difficult for clinicians to quickly access the key points and the key approach that’s relevant in a busy practice.”

EB-Guidelines, he says, “gets to the heart of what’s sapping the joy out of medicine. It doesn’t eliminate individual decision-making, but it makes it easier for clinicians to know what the best practices are and tailor that to their particular patient context. It’s all at their fingertips.”