Five medical schools are launching a joint effort to bring the best information on clinical treatment pathways to patients and physicians in what its developers say is an easy to use form and language.
Harry Jacobson, M.D., describes the new Web-based medical quality company he helped develop as an e-care tool that can improve the cost and quality of care.
Jacobson is vice chancellor for health affairs and professor of medicine at Vanderbilt University, and chairman of the new company, Nashville, Tenn.-based webEBM.
The medical schools at Vanderbilt, Duke University, Emory University, Washington University in St. Louis and Oregon Health Sciences University in Portland are partners in webEBM, which was incorporated in March. EBM stands for evidence-based medicine.
A section of the webEBM.com site has been tested by several physicians at Erlanger Health System in Chattanooga, Tenn., and the full site is being readied for launch in mid-October. The company is backed by $7 million in development funds from Vanderbilt, webEBM management and four venture capital firms.
At the heart of the site are Web-accessible peer-reviewed clinical pathways for what Jacobson says are the 45 most costly, common and catastrophic illness.
They include heart disease, prostate cancer, high cholesterol, asthma and kidney failure. Treatment of these ailments consumes about 55% of healthcare spending, according to webEBM spokesperson Chalayne Sayes. Reducing the variability of treatment plans for these illnesses will improve care and save money, Jacobson says.
The goal, he says, is to have 146 pathways developed by the end of 2001, covering illnesses that account for 92% of healthcare spending in the country.
The webEBM site will have all of its pathways in one place, eliminating the need for doctors to search the Internet or medical journals for up-to-date treatments.
The webEBM pathways are accompanied by decision trees, checklists and outlines to make it easier for physicians to use. Each pathway will have an accompanying lay language version that can be printed out and given to patients.
Patients also will have access to Web tools to track their own progress and provide feedback to the attending physician, the hospital or health system on their compliance and satisfaction with the treatment plan.
The pathways were developed at the medical schools by teams of doctors who will review medical literature and update the pathways at least once every six months, Jacobson says. The pathways are graded based on the underlying science and risk.
Hospitals, health plans and disease management companies are the primary markets for webEBM, Jacobson says. Access to the service will be sold by subscriptions, which cost between $25,000 and $150,000, depending on the size of the system and the services offered.
Michael Millenson, a principal with the William M. Mercer consulting firm in Chicago, says inducing doctors to use the guidelines will be the biggest challenge for webEBM.
"That's more important than the guidelines themselves," he says.
Millenson, the author of Demanding Medical Excellence, says he likes the webEBM idea of translating the guidelines to patient-friendly language, but potential problems may arise if a hospital buys the system and its doctors don't follow the guidelines.
"Do hospitals want patients to know their doctor does anything they want?" he asks.
Steve Weingarten, M.D., is chief executive officer of ZYNX Health, a subsidiary of Cedars-Sinai Health System in Los Angeles, where, for more than seven years, he has urged Cedars-Sinai doctors to follow guidelines he has helped develop.
ZYNX, an outgrowth of that work, also provides medical guidelines. Weingarten says the Institute of Medicine study on medical errors has helped fuel the growth of 4-year-old ZYNX from 30 hospitals to more than 300 hospitals in the past 18 months.
"Doctors are quite receptive to good, high quality rigorous information that they believe is credible," Weingarten says, but "at each local organization you'll need physician champions" to make the system work.
To be most effective, the system needs to be built into the physician's routine work flow, ideally through a physician ordering and record-keeping device that is in the room with doctor and patient, he says.
Weingarten says his system is working toward that goal.