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Implementing Cochrane evidence via EBM Guidelines and EBMeDS

Implementing Cochrane evidence via EBM Guidelines and EBMeDS. Ilkka Kunnamo , MD, PhD Editor-in-Chief, EBM Guidelines & EBMeDS Adjunct Professor of General Practice, University of Helsinki, Finland Disclosure : I am a salaried employee of Duodecim Medical

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Implementing Cochrane evidence via EBM Guidelines and EBMeDS

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  1. Implementing Cochrane evidence via EBM Guidelines and EBMeDS Ilkka Kunnamo, MD, PhD Editor-in-Chief, EBM Guidelines & EBMeDS Adjunct Professor of General Practice, University of Helsinki, Finland Disclosure: I am a salaried employee of Duodecim Medical Publications Ltd., the company that develops and licenses EBM Guidelines and the EBMeDS decision support service. Cochrane Colloquium, Madrid 2011 ilkka.kunnamo@duodecim.fi

  2. The Finnish Medical Society DuodecimDuodecim Medical Publications Ltd. • Scientific society founded in 1881 > 90% of the Finnish physicians as members • Clinical Practice Guidelines • Continuous Medical Education • Medical terminology in Finnish language • Awards and grants for young scientists • 100% owned by the Finnish Medical Society • Electronic publishing since 1989 • Publisher of the national health portal for both professionals and citizens in Finland

  3. History and production of EBM Guidelines • Idea emerged 1987 • Pilotelectronic version on floppydisks 1989 • CD-ROM 1991 • Book 1992 • Liaisonwith the CochraneCollaboration 2000 • Internet 2000 • Mobile 2001 • Computerizedclinicaldecisionsupport 2008 rules (EBMeDS) • Translations in English, German, Russian, Estonian, Hungarian, Slovenian, Dutch, French

  4. Demo

  5. Included in EssentialEvidence Plus

  6. Objective of EBM Guidelines • The right information • by one search term • within one minute

  7. Use of electronic guideline databases in Finland from the professionals’ portal 1.7 guidelines opened per every working-aged physician every day Number of guideline documents opened >12 million/year

  8. Using Cochrane evidence in EBM Guidelines • Evidence summaries are written by salaried physician editors from all Cochrane reviews that are relevant to the topics of EBM Guidelines • 2765 Cochrane reviews are cited in EBM Guidelines evidence summaries by 9/2011

  9. EBM Guidelinesuses a slightlymodified GRADE system

  10. Evidencestatement on patient- importantoutcomes Reasons for downgrading Recommendation Reason for weakrecommendation (valuestatement) Link to Cochrane review

  11. Standard wording for evidence and recommendations • The evidence summaries use standard wording for evidence and recommendations • See www.ebm-guidelines.com/dtk/ebm01066

  12. Updating • Evidence-driven • Continuous scanning of the literature • When new important evidence is published, evidence summaries and recommendations are updated • Both scheduled (every 2 – 3 years) and (interim) continuous updates • The salaried Editorial Team is responsible for initiating the updates

  13. Salaried personnel for guideline development in Finland (excluding nursing and dentistry) • Physician editors 20 • Mostly part-time • Technical editors 6 • Informaticians 2 • IT professionals 5 • Secretaries 3 • Marketing and training 3

  14. Monitoring the use of guidelines • Log files of on-line use • User surveys

  15. Databases accessed in 2010 by health care professionals (Finland) • EBM Guidelines 5 046 070 • Images and videos 1 852 327 • Patient information 1 264 010 • Evidence summaries 226 954 • Calculators (e.g. GFR) 225 562 • Journal articles 1 271 714 Supplementarycontents and toolsthatfacilitateimplementationarevaluedbyusers

  16. The most frequently opened documents in 2010 • GFR calculator 60728 • Urinary tract infections 46470 • PEF calculator 31199 • Lyme borreliosis 31012 • Fungal infections of skin and nails 29195 • Diabetes 28204 • Medical requirements for driving license 26818 • Erysipelas 26028 • Hypothyroidism 25752

  17. The most frequently used search terms in 2010 (translated from Finnish) • Diabetes 47636 • Urinary tract infection 41994 • Asthma 38560 • Gfr 31429 • Pneumonia 27161 • Gout 26933 • Hypertension 23618 • Anaemia 22727 • Sinusitis 22479

  18. Ratio of opened guidelines and evidence summaries • EBM Guidelines Finnish version 93.7 • EBM Guidelines German language version 19.3 • Finnish national Current Care Guidelines via 4.0 professionals’ portal • Finnish national Current Care Guidelines via 1.3 Current Care website • EBM Guidelines English language version 1.1 The ratioreflects the context of use: onlyguidelinesareopenedduringpatientencounters; evidencesummariesareopenedduringlearning (CME) and preparation of presentations

  19. Answers German-speaking countries vs. Finland

  20. Clinical decision support (CDS) • Recommendations in the form of CDS rules trigger reminders automatically if patient data suggest that there is potential for improvement. • Example: The patient has asthma and is using a non-selective beta-blocker – switch to selective beta-blocker

  21. The EBMeDSdecisionsupportservicecanbeintegratedwithanyelectronichealthrecord via XML messaging (seewww.ebmeds.org) Knowledge resources Electronic Health Record EBMeDS Sends patient data (XML request message) Receives decision support (XML response message) Peter Nyberg

  22. Example of decision support and quality reporting for a population of 16 000(a virtual health check) • Cardioselective beta-blockers for patients with asthma: No reminder (selective beta-blocker 32 in use) Reminder: Asthma – switch to selective 4 beta-blocker? Guidelinecompliance = 0.89(n = 36) 89% of patients with asthma and beta-blocker used the right type of beta-blocker.

  23. What can be shared internationally (in addition to full guidelines) • Evidencesummaries • Instructions on how to performprocedures • Images, videos • Patientinformation • Decisionsupporttools • Guidelineauthoring and publishing software

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