The ROI of Evidence Based Protocols

Dale Sanders, CIO, National Health Services Authority, Cayman Islands

A new study from Johns Hopkins reveals the value of standard protocols (aka, clinical practice guidelines) on reduction of central line infections in the ICU–  $1.1M per year. If I were CEO of an insurance company or major employer paying for healthcare, my contracts would require my healthcare providers to show proof that they’ve implemented evidence based protocols to achieve the best patient care and at the lowest cost possible.

Interesting to note that development of this singe protocol/CPG at Johns Hopkins was $160K.  Repeat:  $160K to develop a single protocol.  In the Cayman Islands, we are in the midst of implementing an Evidence Based Practice Strategic Initiative, anchored by a collaborative effort with the British Medical Journal and Cerner.  In only a few months time — which could be compressed to a few weeks with the proper focus — we already have four protocols ready and those will soon be embedded in Cerner’s PowerChart and reflected in Cerner’s Chronic Condition Management reports.  Our cost-per-protocol will be a fraction of $160K as will the Time to First Value.

I find it more and more amazing that anyone practicing medicine today could possibly argue against the adoption of standard evidence based protocols, CPGs and order sets, because adopting them represents a threat to “independent thinking by the doctor.”  (Yes, that’s a genuine quote from a physician).  Further, I find it even MORE amazing that anyone would argue that theses same protocols should be developed internally, rather than through an orders-of-magnitude less expensive service such as that we enjoy through BMJ and Cerner– which will also, by the way, produce a better product than could be produced internally because of the robust process and resources available to BMJ that cannot (and should not) be replicated at every hospital in the world.