Scale and significance of the problem:  Presently it takes approximately 17 years on average for a physician to adopt a level 1 standard of care.  Part of this delay in adopting standards of care is the absence of a standardized method to disseminate tools for implementation.  The adoption of best practices may require tools, checklists, protocols, procedures, medical center memorandum, and computerized order sets. Currently, each hospital and clinic separately designs their own procedures (evidence and systems-based), protocols, tools and guidelines, which are rarely tested, validated, or optimized. Hundreds of man hours of clinicians’ time go into development of these tools. Often committees working on protocols run out of time, or energy, and the tool is lost. When tools are implemented at one facility, they are rarely validated, tested, optimized, maintained, or distributed to others.  While evidence-based and systems-based medicine may be optimal for patient care from the standpoint of safety and efficacy, the absence of a standardized method to implement, optimize, validate, maintain, and disseminate tools that are developed within a single hospital, renders use of such tools, best practice in concept only, wastes staff resources, and fails to provide the best care possible.

Current approaches (nationally) The VA System has 171 medical centers and more than 1000 clinical sites, with little sharing of protocols, checklists, and systems based medicine tools. VA Central Office will provide regulations on what must be accomplished  but the actual tools, checklists, and approaches are left to individual medical centers to develop.  Kaiser Permanente (KP) has 37 medical centers with a system to share systems based medicine tools. KP has a centralized library of validated order sets, checklists, and tools for systems based medicine.

Proposed approach and why it is innovative:  Establish a centralized systems based medicine resource group to optimize, validate, maintain, communicate, promote, distribute, and disseminate tools developed through systems-based and evidence-based medicine in the VA, KP,  and UCSF facilities, utilizing a central repository system. These tools would assist in the implementation of systems-based medicine.  These implementation tools may include protocols, checklists, Apps, memoranda, computerized order sets, and patient care practices. The medical protocols could be checked using epidemiologic analysis of computerized medical records for safety and efficacy. The cost to produce systems based medicine resources would be dramatically reduced by validating already available tools and then distributing them, rather than have each hospital in a system develop tools individually. In the VA, the work to produce a systems based medicine tool would be cut by a factor of more than 100 (1 protocol used in 171 hospitals, rather than each hospital developing their own independently).

Potential Partners:  The systems based medicine resource group could collaborate with Kaiser Permanente, the VA, and UCSF to share systems based medicine tools. KP has borrowed protocols from the SF VAMC. KP has an extensive library of these tools which could provide a basis for the library.

Projected impact, if possible, use back of the envelop calculation to provide quantitative support: A central repository system that effectively disseminates validated tools for implementing best practices would improve availability of evidence and system-based resources to clinicians,  reduce the time and cost for adoption of best practices thereby improving patient care.The result would be improvements in patient outcomes, reduction of mortality rates, reduction of operating costs, improved efficiency, and wider use of evidence and systems-based medicine. Use of individual protocols has reduced mortality rates by 35-50%. Cost savings in the VA are estimated to be a minimum of $1 billion dollars per year.