As physicians, we recognize the importance of evidence based healthcare.  Having  evidence to back up our decisions strengthens our assessments and can give us greater confidence in the treatment paths we decide on for our patients. In busy clinical settings, it’s usually not possible to reference a  particular study that we might be basing our decisions on.  Until now.  Today, we have the tools to quickly access  in real time, the recommendations from that study in the form of a medical algorithm.   Incorporating  evidence into our practice in this way helps substantiate our clinical decisions and ensure timely reimbursement from insurance companies and the government.

Calculate Need for CT-Angiogram

A 66-year old male is brought to the emergency department with a complaint of unilateral leg pain and swelling. He also complains of chest pain and is noted to have tachycardia. The patient is evaluated by the emergency room attending who performs a laboratory and EKG assessment, and also needs to determine whether the patient should receive a computed tomography angiogram (CT-angiogram) to rule out pulmonary embolism. Being able to quickly calculate the need for CT angiography using an algorithm not only helps to incorporate evidence-based medicine into practice, but also reduces the amount of unnecessary radiation exposure for patients. The ER physician can access the Revised Geneva Score for Diagnosis of Pulmonary Embolism in the Emergency Department. Using this algorithm also enables the physician to quickly reference the study in their ER note which improves their documentation and helps to increase the likelihood for reimbursement from the patient’s insurance company.

Not intended to replace the physician’s assessment, a medical algorithm can aid in advanced clinical decision making. This makes the assessment stronger and provides the physician with back-up, knowing that their assessment and plan is also supported by evidence-based medicine.

Determine Treatment for Pharyngitis

A 34-year old female  is seen by an urgent care center and complains of fever and sore throat for the past two days. There are no known sick contacts. Evaluation of the pharynx shows exudates on the tonsils and there is accompanying tender anterior cervical lymphadenopathy. There has been no cough. A rapid strep test is done by the new medical assistant in the urgent care center and is negative.

With the differential of pharyngitis in a 34-year old female being very broad, including numerous viral causes as well as bacterial, the clinician must decide whether  to start an antibiotic prior to receiving results from the throat culture. It is a delicate balance between treating an unconfirmed diagnosis with antibiotics vs. waiting for the culture (taking into account antibiotic resistance). A quick reference via the website or iOS app, using the criteria of Centor et al., to evaluate a patient for streptococcal pharyngitis provides the physician with the probability of a positive culture and in-turn more information to base the decision on whether  to start an antibiotic while awaiting culture results.

Improve Accuracy of Assessments, Increase Reimbursements

Whether practicing in a primary care clinic, emergency room, hospital ward, or intensive care unit, medical algorithms can assist physicians by improving the accuracy of their assessment and plan. The use of medical algorithms can improve outcomes, reduce patient morbidity, and reduce overall healthcare costs and spending. Additionally, with the recent announcement from the Health and Human Services Secretary Sylvia Mathews Burwell indicating that by 2018 the goal is for 50% of Medicare’s physician payments to be based on quality of care provided, rather than quantity; there will now be a shift in medical documentation showing that evidence-based practices have been followed. Doctors and hospitals can use clinical decision tools  to improve the care of patients and increase their reimbursements for providing quality care.