Section 6.5 Optimize
Optimization Strategies for Clinical Practice
Guidelines
Use this tool to incorporate clinical practice guidelines and clinical quality measures into electronic
health record (EHR) systems and other health information technology (HIT).
Time needed: 8 – 12 hours
Suggested other tools: NA
How to Use
1. Review the descriptions below of clinical practice guidelines.
2. Identify the guidelines currently in use in your organization. These may be standing order
sets, specific algorithms, or charting instruments.
3. Identify where other guidelines/pathways may be helpful, based on clinician experience,
quality collaboratives, health plan recommendations, etc. Engage stakeholder groups to
review and approve additional guidelines for use.
4. Determine the source of guidelines/pathways used by the EHR or other HIT vendor. Engage
stakeholder groups to compare these to guidelines you currently use, or plan to use. Select
guidelines/pathways.
Clinical Practice Guidelines
Clinical practice guidelines are statements developed to support provider and client decisions about
therapies and treatments for specific conditions. Although guidelines have traditionally focused on
ensuring a perceived standard of care among local practitioners, the focus is shifting to patient safety
and quality of care—supported by the best available clinical evidence—to support decisions about
what treatments are best for individual clients.
The Agency for Healthcare Research and Quality (AHRQ) has compiled nationally recognized
guidelines from many sources. The National Guideline Clearinghouse (at:
http://www.guideline.gov/browse/by-topic.aspx) is a repository for these guidelines. Guidelines may
also be developed by your facility or specialty society (see resources for such guidelines from the
American Psychiatric Association at: http://www.psych.org/practice/clinical-practice-guidelines).
Guideline formats vary greatly. Some are relatively straightforward sets of statements that can clearly
direct template development in an EHR or other HIT. Such statements are relatively easy to
incorporate into an assessment or care planning process. Guidelines with complex algorithms may
best be used in an automated environment, as they provide the structure for clinical decision support
(CDS) rules. Guidelines in the form of lengthy articles describing the history of the research about a
disease or a differential diagnosis challenge may be difficult to incorporate into a structured data
collection form.
Clinical Quality Measures (CQMs)
Clinical quality measures (CQMs) are related to clinical practice guidelines. They are tools that help
measure and track the quality of health care services. AHRQ also maintains a repository of CQMs at
http://www.qualitymeasures.ahrq.gov/browse/nqf-endorsed.aspx.
Section 6 Optimize—Optimization Strategies for Clinical Practice Guidelines - 1
The Centers for Medicare & Medicaid Services (CMS) uses CQMs in a variety of quality initiatives,
including quality improvement and public reporting. CQMs must be reported to earn incentives
through the CMS program for meaningful use (MU) of EHRs. The Office of the National
Coordinator for Health Information Technology (ONC) certifies EHRs for their ability to accurately
calculate CQM results (for Stage 1) and directly report the e-CQMs from EHRs (for Stage 2) of the
MU incentive program. (For additional information see: http://www.healthit.gov/policy-researchersimplementers/clinical-quality-measures.)
Clinical Practice Guidelines/CQMs Usage
Use the following tool to help track review of clinical practice guidelines and/or clinical quality
measures for inclusion in EHR or other HIT.
Guideline/Measure
(Current/ Proposed)
Social anxiety disorder:
recognition,
assessment, and
treatment guideline
(http://www.guideline.g
ov/content.aspx?id=462
34)
Date of
Review
December
Applicability
Extent of
Usage
Review Against
EHR or Other
HIT
Clients
exhibiting
persistent fear
of or anxiety
about one or
more social or
performance
situations that
is out of
proportion to
the actual
threat posed by
the situation
Therapists
and
psychiatrists
Assessment
template not
available
Action
Modify generic
template to support
this guideline
Clinical Practice Guidelines/CQMs Challenges
You will encounter a number of challenges in implementing using clinical practice guidelines and
CQMs:
1. Clinical practice guidelines are often based on logic, which means they may be overlooked
because of their routine nature. As an example, colorectal cancer screening for patients over
age 50 has been demonstrated to reduce mortality, yet these screening tests are not always
ordered for all eligible patients. Reasons may include things as simple as the lack of a
reminder system.
2. Clinical practice guideline development is costly, with potential for harm if not done
properly. Clinical practice guidelines must be kept up-to-date. In some cases, this may
require responding to new findings. For example, in April 2007, Avandia, used to control
diabetes, was reported to increase risk for heart attacks and death. Although the drug was not
pulled from the market and the findings were questioned, orders immediately dropped.
Health care delivery organizations need to monitor this type of information and engage the
clinical community in making appropriate decisions.
3. To be most widely adopted, clinical practice guidelines need to be incorporated into an EHR
or other HIT. A key element of clinical practice guideline adoption is requiring accurate and
complete data entry. A given guideline may require more data collection than current
documentation reflects. In a busy environment, making the case for the additional
Section 6 Optimize—Optimization Strategies for Clinical Practice Guidelines - 2
documentation time can be difficult. Consideration must be given to downstream time
savings and client benefits.
4. Clinical quality measures may be even more difficult to implement and it may be more
difficult to gain provider acceptance. Ideally, measures should be derived from clinically
accepted guidance. Measurement is impacted by co-morbidities—some of which may not be
known by the provider being measured. For instance, depression is now understood to be an
underlying cause of hospital readmissions for patients who have heart failure or chronic
obstructive pulmonary disease. It is both unhealthy and costly not to follow a depression
screening guideline for such patients. Clinical quality measures require structured data entry
into an EHR, or time-consuming, error-prone, and costly abstraction is required to report on
the measures. For this reason, Stage 2 of the MU incentive program requires use of e-CQMs
(electronic-CQMs).
Copyright © 2014 Stratis Health.
Section 6 Optimize—Optimization Strategies for Clinical Practice Guidelines - 3
Updated 01-01-14