May 28, 2004

Library links medical records to treatment guidelines, teaching materials

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Kristin Price, R.N., who was kissed by the president, smiles over his right shoulder in this cell phone photo captured by resident Kris Kemp, M.D.

Library links medical records to treatment guidelines, teaching materials

Just as has become a more all-purpose Web merchant by adding new categories of goods, the Vanderbilt electronic medical record gains value as systems experts and their clinician partners bring new features and new information into play.

In the latest upgrade, Vanderbilt has connected patient diagnoses to national practice guidelines and patient teaching materials.

Approximately 690 treatment guidelines, along with patient teaching materials for 90 of the most common patient problems, are now linked to the electronic patient problem list.

“There is a wealth of literature indicating that patient questions go unanswered in clinical encounters because physicians lack time, resources, and in some instances expertise,” said Nunzia B. Giuse, M.D., professor of Biomedical Informatics and director of Eskind Biomedical Library. “We are actively working to overcome that barrier by providing easy access to the most relevant and up-to-date evidence-based information at the point of care.”

Selection and organization of the evidence-based guidelines is the work of Eskind librarians. The links are found in StarPanel, a Vanderbilt medical record application supporting disease management and efficient clinic workflow; StarPanel users may view the guidelines and teaching materials for a given patient by selecting the “patient-specific guidelines” link in the problem list.

HealthGate is a company that helps doctors and hospitals adopt evidence-based practice. Vanderbilt is among a group of academic medical centers whose experts are engaged by HealthGate to review evidence and compose practice guidelines. Among the guidelines linked to StarPanel, 90 are supplied by agreement with HealthGate. Those guidelines come with patient teaching materials.

The remaining 600 practice guidelines are issued from a variety of national organizations, and have been compiled by the National Guideline Clearinghouse.

These new links in StarPanel are one more way that Eskind helps clinical teams integrate evidence into their workflow. Eskind is a national leader in bringing library expertise directly to bear on clinical care and the doctor-patient relationship, Giuse said.

Eskind librarians participate in hospital rounds as members of the clinical team, and the library has a consumer health information program devoted to serving Vanderbilt patients and their families.

In another recently established service that Eskind uses to connect clinical teams with medical evidence, Adult Primary Care Center physicians are using the StarPanel messaging feature to send clinical questions to librarians.

The service offers physicians a range of turn-around times from which to select, based on the urgency of their information request.

Giuse said the service can help doctors find published evidence when the guidelines available through StarPanel aren’t adequate to address especially complex or uncommon patient problems. She said some doctors have also begun using the service to help field questions from patients.

Jim N. Jirjis, M.D., assistant professor of Medicine and director of the Adult Primary Care Center, is one of the leaders for the transition to a paperless clinic, and he led the push for links to patient teaching materials. Jirjis has formed a vision of where this initiative may lead. Vanderbilt outpatients may soon use computers in the exam room to view teaching materials, and Vanderbilt hopes to use its patient Web portal at to distribute teaching materials automatically per a patient’s coded diagnoses. Jirjis also hopes eventually to locate resources for adding links from positive lab results in StarPanel to relevant medical evaluation guidelines.

“The computer can become smarter and smarter about having the right information at the right time to deliver evidence-based care,” Jirjis said.

Giuse’s husband, Dario A. Giuse, Ph.D., associate professor of Biomedical Informatics and associate director of the Informatics Center, is the systems expert behind Vanderbilt electronic patient record applications and the Medical Center’s pioneering use of information technology to remove paper-based processes from clinical areas.

Eskind Associate Director Annette M. Williams manages the library’s efforts to link medical evidence to Vanderbilt clinical network applications.