Disseminating Best Practices using CHARTSaaS RA-compliant IT

“Widespread adoption of clinical best practices has been challenging for health systems domestically and abroad. In 2001, an Institute of Medicine report noted that new, evidence-based clinical practices (such as computed tomography screening for lung cancer) can take an average of 17 years to reach patients consistently throughout the health system. Recent reports indicate no improvement in this time lag after 2010. As health systems evolve, rapid change remains a challenge. The ‘learning health system’ is a proposed framework to achieve this goal; however, attempts to put this framework into practice have fallen short. The Department of Veterans Affairs Diffusion of Excellence (VADOE) is a learning health system approach that aligns best practices with system assets (eg, governance structures and common communications platforms) to achieve rapid dissemination of these improvement projects and draws from thoughtful guidelines for dissemination and improvement in health care.” (JAMA. 2017;317(3):255-256. doi:10.1001/jama.2016.18764, http://jamanetwork.com/journals/jama/article-abstract/2598276)

The foregoing abstract of the January 17, 2017, edition of the Journal of the American Medical Association (JAMA) Viewpoint article by Shereef Elnahal, MD, et al entitled “A Framework for Disseminating Clinical Best Practices in the VA Health System” describes the VADOE three-phase methodology for developing and promulgating clinical best practices in a large healthcare provider organization. However, as with other methodologies based on Lean/Six-Sigma process improvement tools and methods, VADOE achieves evidence-based analysis and documentation of improved processes (“Phase I: Identifying Promising Practices”) and creates a fertile and well-controlled environment for process promulgation (“Phase II: Recruit Champions”) but of stops short in its final phase (“Phase III: Replication”) of employing a uniform and reliable means for process replication, which is required to realize the optimal and potentially life-saving case outcomes that are the purpose of clinical standards of care evolving to best practices.

Such a uniform and reliable means is the utilization of an information technology (IT) solution that conforms to the Cloud Healthcare Appliance Real-Time Solution as a Service Reference Architecture (CHARTSaaS RA). A CHARTSaaS RA-compliant IT solution enables healthcare provider subject matter experts (SMEs) such as those described in the article cited above to design, develop and deploy IT applications a.k.a. “apps” with minimal cost and complexity (i.e. — need for specialized IT component configurations or IT staff support). By so doing, SMEs can create automated processes inclusive of decisions, event monitoring, and predictive analytics — all of which can leverage currently installed electronic health record (EHR) systems and other ancillary IT applications — not only to memorialize process improvement information digitally but also to operationalize it in a continuously operating environment that choreographs staff and system actors to achieve clinical results reliably and that enables collaborative and well-controlled continuous process improvement.

Please independently validate and verify to your own satisfaction the capability of a CHARTSaaS RA-compatible IT solution to replicate and to extend the tools and methods of the United States Department of Veterans Affairs Diffusion of Excellence approach to clinical best practice dissemination by reviewing the details in the presentations at these URLS:


Healthcare providers and their patients will benefit significantly from appreciating and then from applying a CHARTSaaS RA-compatible IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths per Makaray and Daniel, http://www.bmj.com/content/353/bmj.i2139), thereby will minimize patient adverse events, and will optimize clinical case outcomes while maximizing cost-effectiveness of care and treatment delivery.

Leave a Reply

Your email address will not be published. Required fields are marked *