Transcript EBMpracticeNet

EBMpracticeNet - Belgium
Stijn Van de Velde
Robert Vander Stichele
Siegfried Geens
EBMpracticeNET: a collaborative effort
Non profit organisation
Open to Belgian organisations that produce EBM
Funding:



–
Reimbursement organisation (National Institute for Health and Disability
Insurance, INAMI-RIZIV)
–
Started in 2011
4 Member groups:

2
–
Government
–
Producers
–
Disseminators
–
Users

Founding members
BCFI
FARMAKA
SSMG
CEBAM
FOD DG 1,2
VIRTUAL LIBRARY
DOMUS MEDICA
KCE
WVVK
E-Health
MINERVA
WVVV
EBMpracticeNet
AIM of the EBMpracticeNet
To optimise quality of care and efficiency by providing all Belgian healthcare
professionals free access to:

1) An up to date database of selected Belgian and international guidelines (GL)
2) Belgian EBM information (other than GL)
3) An electronic clinical decision support system
Primary focus: GP’s
Also muldisciplinary focus for allied health personnel and specialists


3
EBMpracticeNet
Database of guidelines

Working principle:
To be user-friendly the database should provide GL in 80-90% of diagnosis
–
Number of Belgian GL too limited
 need for large amount of foreign GL
 foreign GL need to be adapted
 searching for every missing topic the best foreign GL = not feasible
Topics without Belgian GL:
–
 purchase 1 foreign GL database (with intention to adapt)
4
EBMpracticeNet
Search for a comprehensive database of
guidelines
Main candidates: CKS (UK) en EBM Guidelines (Finland Duodecim).

–
Study Italian Cochrane Centre:
– Internal evaluation:
Banzi R, Liberati A, Moschetti I, Tagliabue L, Moja
1) EB methodology / Editorial
quality
L. A review of online evidence-based practice
2) Coverage
point-of-care information summary providers. J
3) Possibility to link with EPR
Med Internet Res. 2010; 12(3):e26.
4) Adaptability
5) Cost
EBM Guidelines (Finland Duodecim)
5
EBMpracticeNet
Infostructure
EBMpracticeNet
Specific/general
user query
User
authorisation
Access rights
management
Search engine
(ICPC, ICD,
MeSH)
User query
analysis and
routing
Belgian GL
summaries
Belgian EBM
information
Finnish GL
Summaries
Finnish EBMScripts
Computerised
order with decision
support system
Digital
Library
6
EBMpracticeNet
External
EBM
websites
EBM-scripts
EBMeDS
system
Point of
care
7
EBMpracticeNet
EBM-scripts

Evaluation of sample of scripts (by Domus Medica, CAMG, UCL)
–
Key question: Can existing scripts be directly applied to Belgian setting?
–
Methods:
8
•
Identification + analysis of scripts (www.ebmeds.org) for which GL Domus Medica was
available
•
In depth analysis of sample of 10 scripts
EBMpracticeNet
EBM-scripts
Results:

Total nb of scripts n=187
Scripts without DM GL n=148
Scripts with DM GL n=39
-Agreement n=16
-Minor disagreement n=18
-Major disagreement n=5
9
EBMpracticeNet
EBM-scripts
In depth analysis of 10 scripts with disagreements

–
Same main references  different recommendation because of contextual factors
(eg. Obesity)
–
Same references  different interpretation (eg. Hypertension, Diabetes type 2)
–
Different references because of lack in updating  different recommendation (eg.
Hypertension, Antibioticprophylaxis for bites, Obesity)
10
EBMpracticeNet
EBM Scripts - conclusions

Workflow required for evaluation/adaptation/validation of scripts ( and GL)
–
Substantial amount of work
–
Risk of alert fatigue
More
reminders
Less
attention

Careful selection of most important scripts
11
EBMpracticeNet
Organigram
User
query
manager
Functional
analysts
Project leader
Search
path
designers
Editor-in-Chief
Technical staff
Programmers
Secretariat
Indexers
12
EBMpracticeNet
Guideline
abstracters
Redaction
Next steps

Phase 1:
–
–
Selection of priority topics
Definition of work processes
Restructuring Belgian GL to standard template
Linking to Belgian EBM information
Access to GL Duodecim with warning that information is not adapted
Translation of GL Duodecim (see presentation by technical partner IVS)

Phase II:
–
–
Adaption of priority GL for wich no Belgian GL are available
Adaptation of selected EBM scripts

Continuous
–
Update of information
–
–
–
–
13
EBMpracticeNet
Impact evaluation

Collection of data and quality indicators by Ambulatory Care Health
Information Lab – ACHIL

Development of research protocol to evaluate impact on the quality of
care
14
EBMpracticeNet