1. Engaging Physicians with
Evidence-Based Medicine
CMIO Leadership Forum
October 4, 2012
Sameer Badlani, MD, FACP
Chief Medical Information Officer
University of Chicago Medicine

2. Why is engaging physicians important?
- Average amount of time taken for 50% of U.S. physicians to adopt
a published guideline – 17 years (Source: Closing the Quality Gap
Fact Sheet, AHRQ)
- Average adherence to published guidelines by U.S. clinicians –
50% (Source: Elizabeth A. McGlynn, et al N Engl J Med )
- Average amount of money spent creating an EBM rule or guidelines
- $$$$
- Average amount of time spent creating a clinical decision support
rule or an order set – 40 hours
- Value generation from the EHR should be the core driver
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3. Trust in the information
• Who designed this?
• Information services
• Some random committee
• Trusted colleague
• Reputable online source
• Strategies
• Link within the order set or CDS to external
guideline(s)
• Name of the local Subject Matter Expert or
taskforce (Quality committee, Drug safety
task force) who vetted the information
• Grade of the quality of information
• Specialty specific
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4. Transparency/Communication
• What do we achieve or why should I (end user)
care about ….?
• Quality
• Safety
• Cost
• Meaningful Use/SCIP Measures
• Strategies
• Work with quality chairs in clinical domains
• Align specific measures with specific
institutional goals
• Reference relevant information within the
order set or CDS guidance
• Cost factor should only be part of the
discussion and not the only or leading reason
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5. Information Explosion
• Recognize/Measure
• Do you know the number of alerts firing
in your EHR per day? Per physician?
• How many order sets are in production?
• Evidenced based?
• Manage/Audit
• Requirement to review and approve
every year
• Recognize alert fatigue
• Strategies
• Who is the target audience?
• Can you avoid mass exposure?
• Alert fatigue
• Actionable vs. Informative
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6. Difference between Actionable and Informative
• Focus on usability is paramount for sustained engagement
• Strategies
• An alert or order set should always make the right
thing to do easy and in the same screen shot
• There should always be an option for the user to tell
you why he/she is declining the advice
• Don’t assume end users are lazy (they might be)
• The actions within a CDS or order set should be
measurable down to the patient/end user
• Analyze delays in workflow and meaningfulness of the
rule
• There is nothing such as an perfect alert – be willing to
adapt your master piece
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7. Engage the end user
• Build trust in the information
• Transparency of purpose and process
• Manage the information explosion
• Focus on usability
• Celebrate end user involvement – share the credit
• Measure, analyze, adapt
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8. Questions
sbadlani@medicine.bsd.uchicago.edu
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