Want Better Patient Outcomes? Track Physician Adherence to Evidence-Based Medicine

Encouraging physicians to follow evidence-based guidelines and best practices can drive improved patient outcomes.

The electronic health record can be more than a giant billing machine. A newly formed health system is using clinical software to manage order sets and tap current medical knowledge to promote evidence-based medicine.

LaGrangeville, New York–based Health Quest and Western Connecticut Health Network in Danbury, Connecticut, which merged as Nuvance Health in April, have been using clinical software to set alerts, to manage order sets called "power plans," and to give physicians access to the most recent guidelines, best practices, and journal articles.

Health Quest and Western Connecticut Health Network are not operating under the Nuvance Health brand yet.

"We're finding that our increased compliance scores with evidence-based practice are correlating with improved patient outcomes and financial outcomes, which is encouraging. It gives validity to the initiative," says Kelly Philiba, ND, physician informaticist at Health Quest.

Before an evidence-based alert was added to the EMR, compliance with VTE prophylaxis guidelines for heart failure patients was about 70%. After the alert was implemented, compliance increased to 92%.

"We're always attempting to perform at the top of the field, and we want to give our clinicians the resources they need to keep themselves well-apprised on the recommended best practices, emerging evidence, and guidelines," Philiba says.

Measuring adherence to evidence-based practice of medicine
 

Health Quest has more than 700 order sets, and recently reviewed all of them. "We went through every single one with our clinician experts and our software, and input evidence links and revamped any order sets that needed editing," she says.

Now, the health system tracks adherence to order set guidelines by individual physician and clinician cohorts such as cardiologists.

"We are asked to show whether cardiologists are adhering to evidence-based practice and who is not, who is using power plans and who is not, what is the length of stay for a provider who is using evidence-based practices and power plans and what is the length of stay for providers who are not," Philiba says.

Health Quest generates individual provider metrics, group-based metrics, adverse event metrics, and facility-based metrics on quality outcomes including length of stay, morbidity, mortality, and readmission.

Clinicians who do not follow order sets and fall short on clinical outcomes are held accountable for their performance through data presented to a hospital executive such as vice president of medical affairs or group lead, Philiba says. "Having the data and the best practices helps to facilitate the conversation regarding a physician's practice."

The emphasis on following a closely managed order set collection has encouraged physician engagement, she says. "Now that my clinicians have a better understanding of power plans and how they work, they feel more empowered to reach out to the IT department and ask about creating a power plan."

Managing medical knowledge
 

The pace of medical knowledge advancement has accelerated, with the doubling of knowledge estimated at 50 years in 1950 and projected at 73 days next year.

To keep pace, Health Quest is using software from Los Angeles–based Zynx Health to enter updated evidence-based information into the EHR workflows that physicians use daily. With the software, clinicians can click on links to access the latest guidelines, best practices, and peer-reviewed journal articles.  

"The thing that I appreciate about the Zynx evidence links is that they are constantly updated when new articles or new guidelines are published. As a clinician, I find it difficult to know when new guidelines are published because they are on a haphazard schedule. You can't expect new guidelines every year—they come out when the evidence comes out," Philiba says.

The links also give clinicians crucial information at the point of care, she says. "Now that we have the evidence links at the point of care and they are constantly updated, guidance is delivered directly to the clinicians instead of making them search for information."

One of the goals of Health Quest's evidence-based medicine initiative is for the links to give physicians EHR-based decision support, Philiba says. The evidence links enable the review of evidence or guidelines with one click in the EHR. For example, cardiologists can get evidence-based information such as bleeding risk and oxygen utilization for heart failure patients.

"It makes information available in an easy and accessible way," she says.