The future of clinical pathways/guidelines is “alive”.
Standardized approaches to clinical care have been around for more than 50 years (or thousands depending on how you count it), but for all of that time most algorithm/calculator/logic/guideline/pathway content has been static and quickly out of date. Medical science is constantly in flux. Be it new medications, new diagnostics, surgical approaches, new disease discovery (or pandemic), as they say, the one constant is change.
However, in most health care organizations the approach to standard clinical workflows is reactionary and transient. Hardly strategies that offer clinical excellence and financial ROI. Does this sound familiar? A poor patient outcome or disappointing clinical metric crosses the desk of someone in power at your organization. They need to address it somehow. A committee of 5-15 people (who make $200+ per hour) meets sporadically over 6-18 months (50-200 hours of combined time) to develop a standard clinical workflow/pathway to address the issue. Finally they produce a 50 page word document with 4 complex algorithms which is turned into a PDF and posted on the Intranet to live in obscurity somewhere. A listserv email is sent out to clinicians to “follow the algorithm”. For 2 months it works, is out of date within 6 months and forgotten shortly after. The metric moves back to where it was and no one thinks about it till the next time there is a poor outcome.
It’s time to move on.
At Curbside, we believe that clinical standard work should be “alive”. That is, continuously improving with every new understanding about the clinical topic, and even with every use by a practitioner. Gone are the days with paper binders, static PDFs and Visio. It’s time to move from a “document-based” approach of standard work to a “living-application”. New evidence should be continuously monitored and integrated with recommendations updating in near real-time accordingingly. User actions should be analyzed dynamicly to understand how the content is being used and where there might be unintended consequences (or opportunities). End user feedback should flow directly back to the editors, same day to deliver real-time improvements.
The keys to sucess
A collaborative online space to discuss and build pathways - a “Google docs for pathways”
Built-in project management to streamline the create/update process
A centralized exchange to diseminate templated content
Integration at the EHR point-of-care workflow where the clinican “lives”
Advanced analytics that monitor the entire process and drive hypothesis generation
It makes sense why this has happened in the past. It’s just been hard to do until now.
Institutional interia is a hard thing to break, which is why we believe that a new model that is build intrinsically to support a learning health care system through continuous CPG/pathway improvement is necessary. For more information, feel free to chat with us and we’ll show you our approach.
Consider further reading in JAMA Pediatrics about this topic.