Improving Population Health by Modernizing the Implementation of Clinical Guidelines

January 14, 2019 | ASTHO Staff

ASTHO worked with Maria Michaels, public health advisor for CDC’s Deputy Director of Public Health Science and Surveillance, to capture key considerations for state and territorial public health agencies to improve population health by modernizing their implementation of clinical guidelines. Michaels’ background has covered a variety of perspectives, including research, federal health IT regulatory policy, national health IT program implementation, health system health IT program implementation, and public health strategies related to health IT. Below Michaels and ASTHO staff outline how public health agencies can better intersect with healthcare to help ensure that clinical guidelines are implemented as intended and result in the desired health actions and outcomes.

Easily understood clinical guidelines that inform policy at all levels of care are needed to accelerate putting evidence into practice. Clinical guideline developers include a broad diversity of organizations, ranging from single institutions and clinical provider organizations to medical societies and government agencies. CDC, in collaboration with other organizations, develops and publishes clinical guidelines to inform clinical care and public health practice. Clinicians and public health agencies rely on these guidelines to inform policy that shapes clinical decision-making for emerging health threats and population health issues.

Published clinical guidelines are intended to drive action and response between clinical care and public health; however, efforts sometimes fall short due to delays in translating and applying the scientific evidence in practice. Collecting input from all stakeholders during the process of developing and updating guidelines with current evidence-based practices would potentially reduce translation-related issues, which would contribute to more standardized messaging from public health to healthcare. CDC’s Adapting Clinical Guidelines for the Digital Age initiative is taking a stakeholder-driven approach to redesigning the way guidelines are applied in practice. This initiative is concurrently developing tools that help implement those guidelines, with the goal of reducing the lag time in applying guidelines to practice while improving accuracy and consistency.

To build on these concepts, ASTHO has developed a guidebook for State and Territorial Health Officials (S/THOs), Leading Public Health Practice Through Health Informatics and Technology, which provides additional information on achieving bidirectional data exchange and information flow between public health and health care. Key concepts covered in the guidebook include recommendations for:

• Building relationships with health care and community partners
• Equipping S/THOs for data-driven decision making
• Providing strategies to communicate with electronic health record (EHR) vendors
• Investing in resources, including workforce development, to meet the challenges of connecting clinical EHR data to public health surveillance systems.

In short, public health agencies should consider the following steps when leveraging clinical guidelines to support population health outcomes:

• Identify what data are needed from the state or territorial health agency and send that information back in a usable format to the clinical site for point-of-care.
• During a public health emergency, if a health department’s recommendations differ from CDC’s, it presents challenges on clarifying what the clinical staff should do. Therefore, clinical decision support tools should make it clear as to what needs to happen, while considering the responsible public health agency’s protocol for required clinical follow-up.
• Determine what forum is appropriate to support clinical decision support tools (e.g., dashboards, situation rooms for evaluation of analytics, knowledge transfer and exchange networks, clinician processes for navigating information, and algorithms for applying guidelines).
• Develop taskforces and guidelines development boards and committees.
• Consider consumer health advocacy (rights, privileges, representation).
• Determine how to apply public health guidelines into clinical care and apply this to state health improvement plans and community health assessments.