AHRQ EPC Series on Improving Translation of Evidence into Practice for the Learning Health System: Introduction

Fast-Tracking Health Data Standards Development and Adoption in Real-World Settings: A Pilot Approach

BACKGROUND

Pilot-testing is important in standards development because it facilitates agile navigation of the gap between needs for and use of standards in real-world settings and can reveal the practicalities of implementation. As the implementation and use of health data standards are usually more complicated than anticipated, the Office of the National Coordinator for Health Information Technology (ONC) routinely oversees and organizes relevant pilot projects.

OBJECTIVES

This article provides an in-depth look into a sample of ONC's standards-focused pilot projects to (1) inform readers of the complexities of developing, implementing, and advancing standards and (2) guide those seeking to evaluate new standards through pilot projects.

METHODS

The ONC's approach to conducting pilot projects begins with identifying a clinical care need, research requirement, or policy outcome that is not well supported by existing standards through a landscape review. ONC then selects a testing approach based on the identified need and maturity of relevant standards. Next, ONC identifies use cases and sites to pilot-test the relevant standard. Once complete, ONC publishes a report that informs subsequent projects and standards development.

RESULTS

Pilot projects presented here are organized into three categories related to their demonstrated focus and related approach: (1) improving standards for presenting and sharing clinical genetic data, (2) accelerating the development and implementation of new standards, and (3) facilitating clinical data reuse. Each project illustrates the pilot approach from inception to next steps, capturing the role of collaboration among standards development organizations, stakeholders, and end-users to ensure standards are practical and fit for purpose.

CONCLUSION

The ONC approach identifies implementation difficulties prior to broader adoption and use of standards, and provides insight into the steps needed to scale use of standards. The ONC's organization of pilot projects serves as a natural accelerator for building communities of practice, often providing a well-connected beneficiary of lessons learned.

Implementing Evidence-Based Screening and Counseling for Unhealthy Alcohol Use with Epic-Based Electronic Health Record Tools

BACKGROUND

Multiple national organizations recommend screening and counseling adults for unhealthy alcohol use.

METHODS

An evidence-based approach to screening and counseling using Epic electronic health record (EHR) tools was implemented in a general medicine clinic. A dissemination package with actionable steps for clinics and systems wishing to implement similar processes was then produced. To evaluate the initial implementation and quality improvement project, run charts were created to track patients screened, patients counseled, and fidelity to protocols, and members of the original project team were interviewed to assess facilitators and barriers. The draft dissemination package was revised after feedback from health system representatives (key informants).

RESULTS

More than 9,000 patients (73.9% of those eligible) were screened in 20 months. Sixty-four percent of patients with positive initial screens had documented screening-related assessment; 39.7% (141/355) were offered counseling when indicated. Initial project team members identified EHR tools, clinic leadership, quality improvement culture, a multidisciplinary team, and training for providers and nurses as facilitators; and competing demands, patient population size, and nursing staff/resident turnover as barriers. Six key informants evaluated the dissemination package. Most rated 10 of the 12 sections as very useful; all rated components specific to implementing alcohol screening and counseling as very useful. Ratings for general guidance on implementing evidence-based services in primary care were more mixed.

CONCLUSION

Evidence-based screening and counseling for unhealthy alcohol use can be implemented with EHR tools. A dissemination guide was viewed favorably by key informants and can serve as a guide for other clinics and systems.

NxGen evidence: Redesigning the Agency for Healthcare Research and Quality Effective Health Care website to promote engagement, interactivity, and usability of systematic reviews

Evidence‐based decision‐making is predicated on the ability of users to find and comprehend results from systematic review. Evidence producers have an obligation to support evidence users in this process. The Agency for Healthcare Research and Quality (AHRQ) Evidence‐based Practice Center (EPC) program—a producer of rigorous and comprehensive systematic reviews for two decades—has set a gold standard for reliability in health evidence reviews in the United States. It has recently begun a program of active support for evidence dissemination and uptake beyond mere publication of lengthy reports. This Brief Methods Note critiques the current paper‐based format for systematic reviews and describes the development of a next generation (NxGen) AHRQ EPC Effective Health Care website. This redesigned platform will allow end‐users of all types to find and share the evidence they need through data visualizations and other interactive displays. Several design principles guided the development of NxGen to make systematic review findings more accessible, customizable, adaptable, interactive, and shareable. NxGen will include visualizations for report results that are expressed as meta‐analyses as well as those with narrative syntheses, through forest or bubble plots, respectively. Visual and interactive evidence heat maps are also planned. The NxGen version of the Effective Health Care website is planned to go live in the latter half of 2020 or early 2021.

AHRQ EPC Series on Improving Translation of Evidence: Use of a Clinical Pathway for C. Difficile Treatment to Facilitate the Translation of Research Findings into Practice

BACKGROUND

In 2018 the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program issued a call for strategies to disseminate AHRQ EPC systematic reviews. In this pilot, findings from the 2016 AHRQ EPC report on Clostridioides difficile infection were translated into a treatment pathway and disseminated via a cloud-based platform and electronic health record (EHR).

METHODS

An existing 10-step framework was used for developing and disseminating evidence-based clinical pathways. The development of the EHR intervention was informed by the Five Rights model for clinical decision support and human-computer interaction design heuristics. The researchers used observations and time measurements to describe the impact of the EPC report on pathway development and examined provider adoption using counts of pathway views.

RESULTS

Two main themes emerged: (1) discrepancies between the EPC report and existing guidelines prompted critical discussions about available treatments, and (2) lack of guideline and pathway syntheses in the EPC report necessitated a rapid literature review. Pathway development required 340 hours: 205 for the rapid literature review, 63 for pathway development and EHR intervention design, and 5 for technical implementation of the intervention. Pathways were viewed 1,069 times through the cloud-based platform and 47 times through a hyperlink embedded in key EHR ordering screens.

CONCLUSION

Pathways can be an approach for disseminating AHRQ EPC report findings within health care systems; however, reports should include guideline and pathway syntheses to meet their full potential. Embedding hyperlinks to pathway content within the EHR may be a viable and low-effort solution for promoting awareness of evidence-based resources.