Five Drawbacks to Converting Professional Guidelines into Decision Support

Effective decision support must be integrated into the referring physician workflow to qualify for meaningful use incentives beyond 2012 and avoid penalties beyond 2014.

As the radiology community searches for the best source of decision support and decision support to quell inappropriate use, the question of tapping into professional guidelines such as American College of Radiology (ACR) Appropriateness Criteria inevitably arises.

"These guidelines serve many critical functions … but there is little evidence that the traditional methods of guideline dissemination lead to substantial improvement in the test-ordering behavior of referring physicians," wrote Ramin Khorasani, MD, MPH, vice chair of radiology at Brigham and Women’s Hospital.

One of radiology’s top decision support experts, Khorasani identified five drawbacks to converting professional guidelines into decision support:

1. Guidelines are not actionable. Most describe the relative merits of one approach over another rather than prescribe an appropriate course of action.
2. The professional societies that develop and disseminate guidelines fall short on EMR and health IT know-how.
3. Many existing guidelines lack the strength of evidence necessary to spur widespread adoption by clinicians.
4. Effective decision support must be up-to-date and frequently updated.
5. Decision support must incorporate consequences for ignoring rules in order to insure maximum impact.

http://www.cmio.net/index.php?option=com_articles&id=23704

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Issues 2-5 seem relatively straightforward (which isn't to say easy) to address, but issue 1 might require a fundamental rethinking of what constitutes a "professional guideline". What Khorasani calls the "next generation of decision support" may call for the next generation of professional guidelines.