SAN ANTONIO, Texas - The Evidence-Based Practice (EBP) Office at the Army's Medical Command is a busy place, tucked into a basement area of the MEDCOM headquarters building at Joint Base San Antonio, Fort Sam Houston. On any given day, seven Civilian staff can be found in the EBP office hard at work supporting a variety of functions which have, over the past several years of transformation to a System for Health, become mission essential in Army Medicine. The relevance and importance of the expertise in this tiny office of tightly packed cubicles has suddenly become pivotal to the AMEDD's success.
Retired Col. Ernest Degenhardt is the chief of the EBP office and expertly manages his team as they support a variety of high visibility projects. Some of the most important products of the office of EBP are the VA/DoD Clinical Practice Guidelines (CPG). Many don't know it, but the Office of Evidence Based Practice is the executive agent for the DOD in the Evidence-Based Work Group. This group has produced 24 CPGs on a variety of topics, with several new ones scheduled to be released and several others scheduled to be updated over the next year. According to Degenhardt, the VA/DoD have been recognized by industry professional organizations as "some of the best CPGs in the world." Moreover, the Evidence Based Work Group has developed a platform for interagency collaboration which is unsurpassed in the DOD. "All of our CPG's are developed in close coordination with the VHA," says Degenhardt. Each CPG is associated with tools for clinicians, patients, and Families. These tools, such as diabetic meal plans and blood pressure logs, are stored in a warehouse in San Antonio and are available at no cost to Army Medical Treatment Facilities. Many are also available free via internet download, and there are apps for mobile devices currently in development.
A unique and important feature of the VA/DoD CPGs is the use of algorithms to aid clinicians with evidence-based decision support. These algorithms condense the key scientific recommendations for condition management into charts and flow diagrams which make evidence-based recommendations far easier to consume than a text document hundreds of pages long. However, a recent partnership between the EBP office and the Triservice Workflow (TSWF) Team has created the unprecedented opportunity to insert these key scientific recommendations into the workflow of the outpatient clinics by leveraging the electronic medical record known as AHLTA. The TSWF Team creates tools within AHLTA to help standardize and optimize the documentation process of patient encounter notes. Through the use of these TSWF Tools (mainly Alternate Input Method templates, or AIM forms), many clinicians across the Military Health System now have evidence-based decision support available in an easily consumable format right at the point of care. As Degenhardt often says, "What we do in our office doesn't matter if people don't use it." He sees this partnership with the TSWF Team as one of the most remarkable breakthroughs of his career.
In addition to the CPGs which focus on disease and condition management, the EBP office is the AMEDD lead agent for Population Health. Under the Population Health umbrella, numerous functions have recently been brought to life as part of the Patient Centered Medical Home (PCMH) transformation, the evolution and implementation of the Performance Based Adjustment Model (PBAM), and the corporate culture shift from a health care system to a system for health. The EBP staff possesses impressive expertise in the areas of Healthcare Effectiveness Data and Information SET, case management, utilization management, disease management, and medical management, all of which are fundamental components of the population health model of healthcare delivery.
Mr. Degenhardt sees evidence-based practice as the way ahead for the health care industry and for the Army Medical Department, saying, "It supports the operating company model, saves money, and improves outcomes."
The Evidence-Based Practice office website is rich with resources which focus on evidence-based practice. Visit them at https://www.qmo.amedd.army.mil. Customers may also contact the EBP office via phone at 210-221-6527/DSN 471-6527.