Computerizing guidelines to improve care and patient outcomes: The example of heart failure

William M. Tierney, J. Marc Overiiace, Blaine Y. Takesue, Lisa E. Harris, Michael Murray, Dennis L. Varco, Clement J. Mcdonald

Research output: Contribution to journalArticle

160 Citations (Scopus)

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 of 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.

Original languageEnglish
Pages (from-to)316-322
Number of pages7
JournalJournal of the American Medical Informatics Association
Volume2
Issue number5
StatePublished - Sep 1995

Fingerprint

Patient Care
Heart Failure
Guidelines
United States Agency for Healthcare Research and Quality
Electronic Health Records
Quality of Health Care
Clinical Medicine
Microcomputers
Practice Guidelines
Quality Control
Health Care Costs
Physicians
Drug Therapy

ASJC Scopus subject areas

  • Health Informatics
  • Medicine(all)

Cite this

Tierney, W. M., Overiiace, J. M., Takesue, B. Y., Harris, L. E., Murray, M., Varco, D. L., & Mcdonald, C. J. (1995). Computerizing guidelines to improve care and patient outcomes: The example of heart failure. Journal of the American Medical Informatics Association, 2(5), 316-322.

Computerizing guidelines to improve care and patient outcomes : The example of heart failure. / Tierney, William M.; Overiiace, J. Marc; Takesue, Blaine Y.; Harris, Lisa E.; Murray, Michael; Varco, Dennis L.; Mcdonald, Clement J.

In: Journal of the American Medical Informatics Association, Vol. 2, No. 5, 09.1995, p. 316-322.

Research output: Contribution to journalArticle

Tierney, WM, Overiiace, JM, Takesue, BY, Harris, LE, Murray, M, Varco, DL & Mcdonald, CJ 1995, 'Computerizing guidelines to improve care and patient outcomes: The example of heart failure', Journal of the American Medical Informatics Association, vol. 2, no. 5, pp. 316-322.
Tierney, William M. ; Overiiace, J. Marc ; Takesue, Blaine Y. ; Harris, Lisa E. ; Murray, Michael ; Varco, Dennis L. ; Mcdonald, Clement J. / Computerizing guidelines to improve care and patient outcomes : The example of heart failure. In: Journal of the American Medical Informatics Association. 1995 ; Vol. 2, No. 5. pp. 316-322.
@article{7f7bbaa77c414d8a87485e6dde096583,
title = "Computerizing guidelines to improve care and patient outcomes: The example of heart failure",
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 of 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.",
author = "Tierney, {William M.} and Overiiace, {J. Marc} and Takesue, {Blaine Y.} and Harris, {Lisa E.} and Michael Murray and Varco, {Dennis L.} and Mcdonald, {Clement J.}",
year = "1995",
month = "9",
language = "English",
volume = "2",
pages = "316--322",
journal = "Journal of the American Medical Informatics Association : JAMIA",
issn = "1067-5027",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Computerizing guidelines to improve care and patient outcomes

T2 - The example of heart failure

AU - Tierney, William M.

AU - Overiiace, J. Marc

AU - Takesue, Blaine Y.

AU - Harris, Lisa E.

AU - Murray, Michael

AU - Varco, Dennis L.

AU - Mcdonald, Clement J.

PY - 1995/9

Y1 - 1995/9

N2 - 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 of 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.

AB - 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 of 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.

UR - http://www.scopus.com/inward/record.url?scp=0029366053&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029366053&partnerID=8YFLogxK

M3 - Article

C2 - 7496881

AN - SCOPUS:0029366053

VL - 2

SP - 316

EP - 322

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

SN - 1067-5027

IS - 5

ER -