Computerizing Guidelines to Improve Care and Patient Outcomes: The Example of Heart Failure
- William M Tierney,
- J Marc Overhage,
- Blaine Y Takesue,
- Lisa E Harris,
- Michael D Murray,
- Dennis L Vargo,
- Clement J McDonald
- Affiliation of the authors: Department of Medicine, Wishard Memorial Hospital (WMT, JMO, BYT, LEH, CJM). Regenstrief Institute for Health Care (WMT, JMO, BYT, LEH, CJM), Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center (WMT, DLV), Purdue School of Pharmacy (MDM), and Indiana University School of Medicine (WMT, JMO, BYT, LEH, DLV, CJM), Indianapolos, IN
- Correspondence and reprints: William M Tierney, MD, Regenstrief Institute for Health Care, 1001 West Tenth Street, Indianapolis, IN 46202. e-mail: btierney{at}vax1.iupui.edu
Abstract
Increasing amounts of medical knowledge, clinical data, and patient expectations have created a fertile environment for developing and using clinical practice guidelines. Electronic medical records have provided an opportunity to invoke guidelines during the everyday practice of clinical medicine to improve health care quality and control costs. In this paper, efforts to incorporate complex guidelines [those for heart failure from the Agency for Health Care Policy and Research (AHCPR)] into a network of physicians' interactive microcomputer workstations are reported. The task proved difficult because the guidelines often lack explicit definitions (e.g., for symptom severity and adverse events) that are necessary to navigate the AHCPR algorithm. They also focus more on errors of omission (not doing the right thing) than on errors of commission (doing the wrong thing) and do not account for comorbid conditions, concurrent drug therapy, or the timing of most interventions and follow-up. As they stand, the heart failure guidelines give good general guidance to individual practitioners, but cannot be used to assess quality or care without extensive “translation” into the local environment. Specific recommendations are made so that future guidelines will prove useful to a wide range of prospective users.
Footnotes
-
Presented in part at AHCPR-supported Guidelines: A Mid-course Review, Rockville, Maryland, November 7,1994.
-
Supported by grants 1R01HS07763 and 1R01HS07719 from the Agency for Health Care Policy and Research and by contract N01-LM-4-3510 from the National Library of Medicine.
