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Implementing Cochrane evidence via EBM Guidelines and EBMeDS. Ilkka Kunnamo , MD, PhD Editor-in-Chief, EBM Guidelines & EBMeDS Adjunct Professor of General Practice, University of Helsinki, Finland Disclosure : I am a salaried employee of Duodecim Medical

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Implementing Cochrane evidence via EBM Guidelines and EBMeDS

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Implementing cochrane evidence via ebm guidelines and ebmeds

Implementing Cochrane evidence via EBM Guidelines and EBMeDS

Ilkka Kunnamo, MD, PhD

Editor-in-Chief, EBM Guidelines & EBMeDS

Adjunct Professor of General Practice, University of Helsinki, Finland

Disclosure: I am a salaried employee of Duodecim Medical

Publications Ltd., the company that develops and licenses EBM

Guidelines and the EBMeDS decision support service.

Cochrane Colloquium, Madrid 2011

ilkka.kunnamo@duodecim.fi


The finnish medical society duodecim duodecim medical publications ltd
The Finnish Medical Society DuodecimDuodecim Medical Publications Ltd.

  • Scientific society founded in 1881

    > 90% of the Finnish physicians as members

  • Clinical Practice Guidelines

  • Continuous Medical Education

  • Medical terminology in Finnish language

  • Awards and grants for young scientists

  • 100% owned by the Finnish Medical Society

  • Electronic publishing since 1989

  • Publisher of the national health portal for both professionals and citizens in Finland


History and production of ebm guidelines
History and production of EBM Guidelines

  • Idea emerged 1987

  • Pilotelectronic version on floppydisks 1989

  • CD-ROM 1991

  • Book 1992

  • Liaisonwith the CochraneCollaboration 2000

  • Internet 2000

  • Mobile 2001

  • Computerizedclinicaldecisionsupport 2008

    rules (EBMeDS)

  • Translations in English, German, Russian, Estonian, Hungarian, Slovenian, Dutch, French



Implementing cochrane evidence via ebm guidelines and ebmeds

Included in EssentialEvidence Plus


Objective of ebm guidelines
Objective of EBM Guidelines

  • The right information

  • by one search term

  • within one minute


Use of electronic guideline databases in finland from the professionals portal
Use of electronic guideline databases in Finland from the professionals’ portal

1.7 guidelines opened

per every working-aged

physician every day

Number

of guideline

documents

opened

>12 million/year


Using cochrane evidence in ebm guidelines
Using Cochrane evidence in EBM Guidelines professionals

  • Evidence summaries are written by salaried physician editors from all Cochrane reviews that are relevant to the topics of EBM Guidelines

  • 2765 Cochrane reviews are cited in EBM Guidelines evidence summaries by 9/2011


Implementing cochrane evidence via ebm guidelines and ebmeds

EBM professionalsGuidelinesuses a slightlymodified GRADE system


Implementing cochrane evidence via ebm guidelines and ebmeds

Evidence professionalsstatement on patient-

importantoutcomes

Reasons for downgrading

Recommendation

Reason for weakrecommendation (valuestatement)

Link to Cochrane review


Standard wording for evidence and recommendations
Standard wording for evidence and recommendations professionals

  • The evidence summaries use standard wording for evidence and recommendations

  • See www.ebm-guidelines.com/dtk/ebm01066


Updating
Updating professionals

  • Evidence-driven

    • Continuous scanning of the literature

    • When new important evidence is published, evidence summaries and recommendations are updated

  • Both scheduled (every 2 – 3 years) and (interim) continuous updates

  • The salaried Editorial Team is responsible for initiating the updates


Salaried personnel for guideline development in finland excluding nursing and dentistry
Salaried personnel for guideline development in Finland professionals(excluding nursing and dentistry)

  • Physician editors 20

    • Mostly part-time

  • Technical editors 6

  • Informaticians 2

  • IT professionals 5

  • Secretaries 3

  • Marketing and training 3


Monitoring the use of guidelines
Monitoring the use of guidelines professionals

  • Log files of on-line use

  • User surveys


Databases accessed in 2010 by health care professionals finland
Databases accessed in 2010 by health care professionals (Finland)

  • EBM Guidelines5 046 070

  • Images and videos1 852 327

  • Patient information1 264 010

  • Evidence summaries 226 954

  • Calculators (e.g. GFR) 225 562

  • Journal articles1 271 714

    Supplementarycontents and toolsthatfacilitateimplementationarevaluedbyusers


The most frequently opened documents in 2010
The most frequently opened documents in 2010 (Finland)

  • GFR calculator 60728

  • Urinary tract infections 46470

  • PEF calculator 31199

  • Lyme borreliosis 31012

  • Fungal infections of skin and nails 29195

  • Diabetes 28204

  • Medical requirements for driving license 26818

  • Erysipelas 26028

  • Hypothyroidism 25752


The most frequently used search terms in 2010 translated from finnish
The most frequently used search terms in 2010 (Finland)(translated from Finnish)

  • Diabetes 47636

  • Urinary tract infection41994

  • Asthma 38560

  • Gfr 31429

  • Pneumonia 27161

  • Gout 26933

  • Hypertension 23618

  • Anaemia 22727

  • Sinusitis 22479


Ratio of opened guidelines and evidence summaries
Ratio of opened guidelines and evidence summaries (Finland)

  • EBM Guidelines Finnish version 93.7

  • EBM Guidelines German language version 19.3

  • Finnish national Current Care Guidelines via 4.0 professionals’ portal

  • Finnish national Current Care Guidelines via 1.3 Current Care website

  • EBM Guidelines English language version 1.1

The ratioreflects the context of use: onlyguidelinesareopenedduringpatientencounters; evidencesummariesareopenedduringlearning (CME) and preparation of presentations



Clinical decision support cds
Clinical decision support (CDS) (Finland)

  • Recommendations in the form of CDS rules trigger reminders automatically if patient data suggest that there is potential for improvement.

  • Example:

    The patient has asthma and is using a non-selective beta-blocker – switch to selective beta-blocker


Implementing cochrane evidence via ebm guidelines and ebmeds

The (Finland)EBMeDSdecisionsupportservicecanbeintegratedwithanyelectronichealthrecord via XML messaging (seewww.ebmeds.org)

Knowledge

resources

Electronic

Health

Record

EBMeDS

Sends patient data (XML request message)

Receives decision support (XML response message)

Peter Nyberg


Example of decision support and quality reporting for a population of 16 000 a virtual health check
Example of decision support and quality reporting for a population of 16 000(a virtual health check)

  • Cardioselective beta-blockers for patients with asthma:

    No reminder (selective beta-blocker 32

    in use)

    Reminder: Asthma – switch to selective 4

    beta-blocker?

    Guidelinecompliance = 0.89(n = 36)

89% of patients with asthma and

beta-blocker used the right type

of beta-blocker.


What can be shared internationally in addition to full guidelines
What can be shared internationally population of 16 000(in addition to full guidelines)

  • Evidencesummaries

  • Instructions on how to performprocedures

  • Images, videos

  • Patientinformation

  • Decisionsupporttools

  • Guidelineauthoring and publishing software


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