mudr. vojtech huser phd
DESCRIPTION
Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU. MUDr. Vojtech Huser PhD. Agenda. Introduction Ultra-brief examples of Non-executable representations Executable representations - PowerPoint PPT PresentationTRANSCRIPT
Overview of approaches for translating clinical guidelines into
routine careCurrent trends in USA and possible lessons for Czech republic
and EU
MUDr Vojtech Huser PhD
Vojtech Huser MD PhDVojtech Huser MD PhD
2
Agenda Introduction Ultra-brief examples of
Non-executable representations Executable representations
Status quo in USA Related topics
Quality improvement Pay for performance Lessons applicable to Czech repEU Future trends
httpwwwlinkedincominvojtechhuser
Vojtech Huser MD PhDVojtech Huser MD PhD
3
Background points Increasing number of clinical guidelines
communications of updates to clinicians Hard to follow -gt computerized guidelines executable
Varying quality of guidelines Involvement of professional societies
Eg EuropeanCzech society for endocrinology New technology adoption
Yong physicians more used to work with healthcare IT
Vojtech Huser MD PhDVojtech Huser MD PhD
4
Methods Several examples Not comprehensive overview
Selected subset Focusing on lessons learned rather then results
of a particular project
httpwwwncbinlmnihgovpubmedterm=Huser V [Author] wwwintermountainhealthcareorg wwwmarshfieldclinicorgBIRC
Vojtech Huser MD PhDVojtech Huser MD PhD
5
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
2
Agenda Introduction Ultra-brief examples of
Non-executable representations Executable representations
Status quo in USA Related topics
Quality improvement Pay for performance Lessons applicable to Czech repEU Future trends
httpwwwlinkedincominvojtechhuser
Vojtech Huser MD PhDVojtech Huser MD PhD
3
Background points Increasing number of clinical guidelines
communications of updates to clinicians Hard to follow -gt computerized guidelines executable
Varying quality of guidelines Involvement of professional societies
Eg EuropeanCzech society for endocrinology New technology adoption
Yong physicians more used to work with healthcare IT
Vojtech Huser MD PhDVojtech Huser MD PhD
4
Methods Several examples Not comprehensive overview
Selected subset Focusing on lessons learned rather then results
of a particular project
httpwwwncbinlmnihgovpubmedterm=Huser V [Author] wwwintermountainhealthcareorg wwwmarshfieldclinicorgBIRC
Vojtech Huser MD PhDVojtech Huser MD PhD
5
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
3
Background points Increasing number of clinical guidelines
communications of updates to clinicians Hard to follow -gt computerized guidelines executable
Varying quality of guidelines Involvement of professional societies
Eg EuropeanCzech society for endocrinology New technology adoption
Yong physicians more used to work with healthcare IT
Vojtech Huser MD PhDVojtech Huser MD PhD
4
Methods Several examples Not comprehensive overview
Selected subset Focusing on lessons learned rather then results
of a particular project
httpwwwncbinlmnihgovpubmedterm=Huser V [Author] wwwintermountainhealthcareorg wwwmarshfieldclinicorgBIRC
Vojtech Huser MD PhDVojtech Huser MD PhD
5
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
4
Methods Several examples Not comprehensive overview
Selected subset Focusing on lessons learned rather then results
of a particular project
httpwwwncbinlmnihgovpubmedterm=Huser V [Author] wwwintermountainhealthcareorg wwwmarshfieldclinicorgBIRC
Vojtech Huser MD PhDVojtech Huser MD PhD
5
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
5
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
6
GEM Guidelines element model Yale University Set of tools (eg GEM cutter) Improve quality of the textual guidelines Semi-structured format
httpwwwniceorguk(NHS Evidence)
httpneoeuromiseczkkdp
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
7
Arden Syntax Representation language for simple rules Complex guidelines have to be handled by set
of Arden MLMs (Medical Logic Modules) Formally accredited standard (HL7) Accepted by several EHR vendors
McKesson Siemens
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
8
Arden Syntax example
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
9
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
10
GLIF Guidelines
Interchange format
Graphical editor (Proteacutegeacute)
Limitedadoption
Researchimplementation
httphealthcareworkflowwordpresscom
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
hellip and numerous other formats
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
12
Current state of the art (USA) (executable guidelines)
Legal status Meaningful use of EHR
Use of decision support within an EHR system Financial incentives Government agencies (AHRQ) Office of National Coordinator (ONC) AMIA lobbying efforts in Congress
Vendors and societies Professional societies adoption
Early adopters (eg ACP httppieracponlineorg) Vendor specific decision support platforms
Vendors compete on default knowledge content in EHR system Additional knowledge bases for sale Client forums inter-client exchange of knowledge content
Research based decision support platforms Knowledge vendors
Thomson Reuters Order sets Zynx TheraDoc
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
13
Related Quality Improvement Research
Research on quality of care provided Secondary Use of Data Administrative billing data + clinical data httpwwwhmoresearchnetworkorgmembershtm Medicare Medicate data set available to university-based researchers Link of guidelines to QI
Truely modern medicual guidline may have a bdquoRelatedSuggested quality measures sectionldquo bdquocoded termsldquo bdquorelevant billing or SNOMED-CT codesldquo
Legislation business environment health plans compete for patients based on quality of their contracted providers
Healthcare Effectiveness Data and Information Set (HEDIS)
accreditation (JCAHO) is condition of Medicare contract
Pay for performance contracts Investment into redesign healthcare provider network Benefits to payor (health plan (insurance company) savings Problem decreased revenue (inpatient) same system vs competitor system Integrated environment outpatient and inpatient facilities + health plan
httpskvalitanrcczukazatele httpwwwsakcrcz
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
14
Lessons applicable to Czech repEU Not every aspect applies to EUCZ Few possible ones
More reports available to consumers on guidelines adoption (QI measures)
Complement Clinical Data to Administrative Data NRC level -gt local level Linking data from several sources in a research data warehouse
Direct financial incentives (chief quality officer internal measures) Limited reporting of quality measures to payors (similar to newly introduced CPT results
codes) healthcare consumer empowering
right to export electronic version of all clinical data (HITEC part of ARRA)) increased education of professional societies about executable guielines approaches and
standards Market place changes (integrated decision support third party decision support
(legislative changes) legistative changes defining healthcare data deidentification levels and secondary use of
EHR data in research Clear rules about waiver of consent Primary care GP data set Medicare data set (in non-UK context)
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
15
Future trends International cooperation and better structured guidelines
Eg G-I-N approach
Exchange of executable guidelinesguideline elements Decision support mandate from meaningful use (USA from 2015)
Tight coordination of clinical guidelines with quality improvement measures and decision support
Secondary use of data healthcare data privacypublic healthimproved research
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-
Vojtech Huser MD PhDVojtech Huser MD PhD
16
Summary Goals
1 executable guidelines 2 trends in USA 3 implications for CZEU and future trends
Questions vojtechhusergmailcom
httpwwwlinkedincominvojtechhuser
- Overview of approaches for translating clinical guidelines into routine care Current trends in USA and possible lessons for Czech republic and EU
- Agenda
- Background points
- Methods
- GEM
- Slide 6
- Arden Syntax
- Arden Syntax example
- Slide 9
- GLIF
- hellip and numerous other formats
- Current state of the art (USA) (executable guidelines)
- Related Quality Improvement
- Lessons applicable to Czech repEU
- Future trends
- Summary
-