Hardcoding Choosing Wisely Canada Recommendations into Sherbrooke’s EMR System
Project Lead: Dr. Ariel Masetto
In 2014, one year after the launch of the national Choosing Wisely Canada (CWC) campaign, physicians at Sherbrooke University began to organize local Choosing Wisely meetings. Strategies began to take shape, regarding how to implement CWC recommendations, as well as how to address the appropriate use of scarce medical resources. Despite initial enthusiasm regarding local implementation, interest wore off, and no concrete changes in practice occurred. Now, inspired by successful experiences observed at other Canadian medical institutions, Sherbrooke is aiming to adopt a better strategy in 2016 – a strategy to actually change medical practice at the teaching hospital ‘Le Centre Hospitalier Universitaire de Sherbrooke’ (CHUS).
Under the guidance of Dr. Ariel Masetto, Assistant Professor, Department of Rheumatology, the University of Sherbrooke recently received an internal grant to develop IT resources that will hardcode CWC recommendations into CHUS’s EMR. At CHUS, diagnostic tests are prescribed by a computerized physician order entry (CPOE) system. Their approach will be to add a function to their existing software that automatically generates a pop-up window presenting the Choosing Wisely Canada recommendation as clinical decision support for some targeted radiologic tests. An example of this pop up will be when a CPOE prescription for a magnetic resonance imaging (MRI) scan is ordered for lower back pain, a pop-up will briefly remind users of its recognized scientific indications. A second function will generate a dashboard allowing physicians and residents to consult their own statistics about tests prescribed within the last year, comparing themselves anonymously to their peers. This exercise will allow physicians to easily obtain Type 3 credits from the CRCSP.
Even though Dr. Masetto and the Sherbrooke Choosing Wisely Team are more optimistic than in 2014, they remain conscious that changing practice is one of the largest institutional challenges hospitals faces. They hypothesize that a few inexpensive electronic resources promoting continuous educational feedback could be a pragmatic strategy to promote changes in practice patterns.