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Clinical Practice Guidelines: Scaling for the Moments of Care

by Anne Meneghetti, MD, Executive Director of Medical Information, Epocrates

I have empathy for those groups of expert clinicians who establish clinical practice guidelines. They sequester themselves in hotel conference rooms for days to create a document that’s part evidence-based analysis and part expert opinion. In the end, the resulting guideline may bear little semblance to what any of its authors do in practice. These freshly minted guidelines are typically very lengthy, and hard to apply to complex patients. Annoyingly, opinions on guidelines can differ from one specialty society to the next.

Increasingly, when evidence is lacking, guidelines leave decision-making up to the clinician and patient preference. Yet, health care providers love — and need — clinical practice guidelines more than ever.

Bringing CPGs to Point-of-Care

There’s growing evidence that adhering to clinical practice guidelines (CPGs) can improve care outcomes. The challenge is in distilling relevant guideline-based insights into decision-making during the moments of care.

Take the example of atrial fibrillation, one of the most common conditions seen by primary care clinicians, according to electronic health record data from athenahealth’s cloud-based network. It’s a complicated topic full of options: rate vs. rhythm control, pharmacology vs. procedural approaches, antithrombotic prevention or not. So it’s no surprise that the 2014 American College of Cardiology afib guideline is over 100 pages long — far from optimal reading at the point of care. Who can glean relevant best practices from a lengthy PDF while a 62-year-old patient with hypertension, hyperlipidemia, type 2 diabetes, and nonvalvular afib is waiting for treatment?

A Triumph of Epocratization

Here’s where moment-of-care applications like Epocrates come in. We’ve translated top CPGs from major medical specialty societies into actionable and concise guidance organized by patient type. We call this hyper-succinct, patient-specific tailoring “Epocratization.” Our new, free interactive “Epocratized” versions of CPGs are structured exactly how you’d want them to be: designed to match the patient in front of you.

Once you’ve chosen a patient type, we deliver succinct, key, actionable recommendations from relevant sections of the guideline, scaled to fit right into your workflow. When a deeper dive is necessary, one tap to a reference link calls up the full guideline, direct from the source organization.

I encourage you to explore our new Epocrates Guideline synopses. If you have any suggestions for new Guideline topics, we welcome your recommendations at any time. Send us a note or leave a comment below.

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