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In , Bockmann and Heiden described a model-driven approach for breast carcinoma that was similar to our methods described here. The ability to apply evidence-based guidelines to multiple HIS with ease is imperative for the future of improving the delivery of medical care to patients.
The development of our database, utilizing a single-source of evidence-based guidelines, should allow for the future integration of this knowledge across all EHRs. It is clear that several systems have recognized that standardizing medical care can improve outcomes, but the delivery of evidence-based knowledge and protocols is not always easy to execute within a digital platform, especially with the vast number of guidelines available to providers.
We believe this will help improve compliance with evidence-based guidelines, improve physician satisfaction, and may improve patient care and outcomes. Additionally, as guidelines are integrated into the EHR, we will be able to study the quality of care and this could help inform new guideline development. Work is underway to expand the database to include gynecologic guidelines, and we will continue to update the current obstetrical guidelines. The database we have created has been applied to a current EHR system as clinical decision support in obstetrics, and there is ongoing work to evaluate the benefits of its use.
This project provides a single source of truth database of ACOG recommendations, organized, and referenced, and continually updated. This library can be used as the basis for development of care pathways. Strengths of our process include a systematic approach, using a well-established knowledge source, and having a mechanism in place for regular updating of the data. A limitation that this process exposes are the many gaps in evidence-based medicine.
The available recommendations are frequently insufficient to form a complete care pathway. How to bridge this gap is an ongoing discussion within ACOG, and a great subject for further investigation.
Additionally, it is equally important that an infrastructure for automatic updates and standard care pathways is developed to ensure there is only one version of each care pathway across all EHRs. Translation of narrative documents into a format that is easily consumable by a digital platform must be done in a careful, formalized process. We have described such a process and executed the resulting database within a commercial product.
We have described a methodology of translating ACOG narrative into a semi-structured format that can be more easily applied as clinical decision support in the EHR. We believe this work can contribute to developing a library of information within ACOG that can be continually updated and disseminated to the EHR systems. By integrating evidence-based guidelines into the EHR through decision support, we believe this can help providers deliver safer and more efficient care to patients.
Correct Answer: The correct answer is option c. Clinical decision support should provide the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. It is an example of clinical decision support through providing a pertinent reminder for a test that should be ordered at the point of care.
Correct Answer: The correct answer is option b. Semi-structured knowledge is formatted as organized text where structure is added to a narrative guideline. The authors would like to thank A. They also thank S. Conflict of Interest None declared. All referenced content and materials were provided to the authors for purposes of further analysis in this publication. The methodology described in this publication is considered proprietary and is not intended for commercial consumption, promotion, or product development.
Appl Clin Inform. Published online Sep 1. Brittany H. Sanford , 1 Gabriel Labbad , 2 Alyssa R. Hersh , 3 Aya Heshmat , 4 and Steve Hasley 5. Alyssa R. Author information Article notes Copyright and License information Disclaimer.
Address for correspondence Brittany H. Received Apr 26; Accepted Jul 6. Copyright Thieme. All rights reserved. Keywords: clinical decision support, obstetrics, medical informatics, electronic health records. Background and Significance The American College of Obstetricians and Gynecologists ACOG provides numerous types of narrative documents that offer guidance for clinical care, including practice bulletins, committee opinions, practice advisories, endorsed guidelines, and task force publications.
Objectives We sought to translate ACOG clinical guidance into clear, implementable clinical decision support associated with specific obstetrical problems. Methods To translate ACOG clinical guidance into implementable clinical decision support, we followed the set of steps outlined below.
Selection of Documents ACOG has an extensive library of documents that contain guidance for obstetric and gynecologic care. Extraction, Classification, and Assigning Tasks to Recommendations We extracted called-out recommendations from the selected documents. Table 1 Types of recommendations. Recommendation type Count a Description Example Action A recommendation with a specific task associated with the recommendation. Refer patients for oral health care with a written note or call, as would be the practice with referrals to any medical specialist.
Open in a separate window. Table 2 Types of orders. Order consultation 53 Consult maternal fetal medicine Review consult note Questions for patient 21 Have you had a flu shot?
Patient education 20 A healthy pregnancy for women with diabetes FAQ 24 Not applicable Requests for provider input 12 Does this patient have obstructive sleep apnea?
Order nonstress test. Order biophysical profile. If oligohydramnios present, consider induction. Admit to hospital orders 2 Schedule the patient for an ECV if she does not have contraindications.
ECV is contraindicated if vaginal delivery is not clinically appropriate. If yes, add it. Business Process Model and Notation A single recommendation in isolation is not as useful as a series of recommendations joined together into a care pathway. Information Rh negative and pregnancy 1 Practice Bulletin management of alloimmunization in pregnancy. Table 4 Number of documents by type. Recommendations We extracted a total of 1, recommendations from the source documents average: 5. Table 5 Distribution of clinical problems with related recommendations.
Timing of Recommendations in Regard to Obstetrical Practice Recommendations were also categorized by the time period that they would be pertinent during the obstetrical care of a patient Table 6. Table 6 Timing of recommendations in regard to obstetrics practice.
Business Process Model and Notation We have provided an example of how the information gathered has been constructed in an executable pathway using BPMN. Discussion Utilizing the framework described by Boxwala et al, our paper describes the process of translating ACOG narrative into a semi-structured format. Conclusion Translation of narrative documents into a format that is easily consumable by a digital platform must be done in a careful, formalized process.
Clinical Relevance Statement We have described a methodology of translating ACOG narrative into a semi-structured format that can be more easily applied as clinical decision support in the EHR. Multiple Choice Questions Which of the following is an example of clinical decision support?
Acknowledgments The authors would like to thank A. Funding Statement Funding None. References 1. Chicago, IL: Effect of clinical decision-support systems: a systematic review. Ann Intern Med. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. Gooch P, Roudsari A. Computerization of workflows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems.
Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. A multi-layered framework for disseminating knowledge for computer-based decision support.
Practice Bulletin No. Practice bulletin no. Obstet Gynecol. ACOG practice bulletin no. Translating clinical guidelines into practice: challenges and opportunities in a dynamic health care environment. Care pathways in obstetrics: the effectiveness in reducing the incidence of episiotomy in childbirth. J Nurs Manag. Extracting and transforming clinical guidelines into pathway models for different hospital information systems.
Health Inf Sci Syst. Factors influencing implementation success of guideline-based clinical decision support systems: a systematic review and gaps analysis. Int J Med Inform. ACOG committee opinion no. Prevention of group B streptococcal early-onset disease in newborns: ACOG committee opinion, number Committee Opinion No Committee opinion no.
ACOG practice bulletin no obesity in pregnancy. External Cephalic Version. External cephalic version: ACOG practice bulletin, number Copy Download.
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Featuring patient-friendly language and the latest ACOG guidance, this edition contains inclusive content on prepregnancy health and planning, pregnancy, labor and delivery, and the postpartum period. Buy More, Save More. As an exclusive member benefit, ACOG members receive additional savings on bulk orders. Non-members save as well by ordering in bulk.
For quantities more than , please contact sales acog. Digital Pamphlet Subscription Access the most up-to-date patient education materials online and on demand. Subscribers can download, print, and provide ACOG resources to patients anytime for extra support and guidance. Ability to download PDF files and print on demand; email copies to patients via email account or message-sharing system.
This list is subject to change as inventory runs out. View and order available print pamphlets at acog. Concise handouts with key takeaways and easy-to-skim facts for patients. Digital Pamphlets In-depth handouts with comprehensive guidance for patients. Offers the same information as traditional print pamphlets. Patients can purchase e-books to read on their computer, phone, or e-reader.
Share the patient website with your patients today: acog. This poster explains the importance of getting the influenza and Tdap vaccinations during pregnancy by illustrating how maternal antibodies are created and explaining how they protect newborns. The poster emphasizes vaccine safety and effectiveness. This timely resource explains the recommended treatment for opioid use disorder during pregnancy.
The information focuses on treatment�how it works, why it matters, and the effects it can have on a newborn. Item No. The messaging emphasizes toning the muscles of the abdomen and back and includes Kegel exercises. This poster explains the risks of drinking alcohol during pregnancy, focusing on alcohol-related birth defects such as fetal alcohol syndrome, and encourages pregnant people to avoid alcohol during pregnancy.
Tobacco and Pregnancy Educate your patients on the risks of smoking and vaping during pregnancy. The poster highlights smoking-related risks to the fetus, newborn, and pregnant patient and offers information on how to get help quitting. My Postpartum Care Tear Pad Designed to be distributed during the last trimester, or before patients leave the hospital, this tear pad serves as a tracking log for postpartum concerns. Encourage patients to record concerns about recovery and bring the checklist to their first postpartum checkup.
One side is in English; the other is in Spanish. Your Postpartum Care Team Poster This colorful poster encourages pregnant patients to create a postpartum care team prior to delivery. Wall-Mountable Rack The wall-mountable display holds copies of 12 patient education pamphlets of your choice.
This handsome rack is solid oak with acrylic dividers. Patients can search the directory for ob-gyns by name, location, subspecialty, and languages spoken. With more than , visitors monthly, our website is a go-to resource for patients.
Build your profile and appear in the directory within minutes. Connect patients to your practice. Sign up today at acog. This joint publication by ACOG and the American Academy of Pediatrics focuses on reproductive awareness, patient safety, and quality improvement of perinatal care.
A classification system for levels of maternal care has been added along with screening for preterm delivery risk, the timing of umbilical cord clamping, and a discussion of safety bundles.
Retaining much of the original text, including explanations of forceps devices and technique, this volume provides the latest related ACOG guidelines, a chapter on vacuum assisted deliveries, and information on the current and changing status of forceps deliveries. This resource is designed for physicians of all specialties and represents the collaborative efforts of ACOG and the American Academy of Pediatrics. This updated edition contains new information on the benefits of breastmilk to preterm infants.
For more information, please visit acog. Neonatal Encephalopathy and Neurologic Outcome, Second Edition This edition, reaffirmed in , updates the scientific and clinical knowledge on neonatal encephalopathy and neurologic outcomes. Updated sections include placental pathology, focal ischemic stroke, neonatal interventions, patient safety, and the significant advances in neuroimaging.
Neonatal Brachial Plexus Palsy This ACOG task force report is an appraisal of the available peer-reviewed literature on this subject and the existing state of knowledge of the etiology, prediction, management, and treatment of neonatal brachial plexus palsy.
Past issues will still be available and withdrawn as their CME credit expires. The series is published online six times a year and focuses on screening, prevention, evaluation, diagnosis, initial management, and referral approaches. Each monograph features relevant anatomy, physiology, and pathophysiology visuals; evaluation and management algorithms; tables and figures; checklists and links to current practice guidelines; additional resources for patients and physicians; and a CME quiz.
Stay up to date the easy way and earn five CME credits. Free to most ACOG membership categories. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Put your knowledge to the test and earn up to 25 CME credits! Online assessments are available for ALL current editions. Additional information on how to purchase and retrieve an eBook or digital version of a physical product is located on each product webpage. For more information, visit acog. Purchase All Six Books and Save!
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