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From Paper to Practice: Digitizing and Living Clinical Guidelines · Voices of Otolaryngology

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Welcome to the Voices of Otolaryngology podcast series, where we spotlight
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diverse perspectives and insights within the field of otolaryngology.
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I'm your host, Rahul Shah.
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Let's jump into it.
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Welcome to the voices of otolaryngology.
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I am so excited today to have Maria Michaels and Doctor Margo McKenna with us.
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Today we're going to talk about digitizing guidelines.
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Living guidelines.
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Us three are really excited about it.
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And we're confident at the end of this 30 minutes or so, you, too,
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are going to be excited about the horizon in guidelines.
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I'd like to introduce Maria Michaels.
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She'll tell you a little bit about herself.
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So my name is Maria michaels.
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I'm actually here in my personal capacity.
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But I have done a lot of work in the area of digitizing guidelines.
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In some of the jobs I've had in the past.
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So, that includes the agency for Health Care Research and Quality,
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the centers for Disease Control and Prevention.
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And, through my role as chair of the guidelines
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International Network North America region.
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Again, I am representing myself only in this, in this podcast.
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Awesome.
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So you can answer this question the best as representing yourself only,
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could you tell us about your training,
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background, education a little bit and then we'll go to doctor McKenna?
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Well, I've, studied biology
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and psychology, and do have an MBA,
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so I have a little bit of science and business background.
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I've worked in, clinical research,
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actually a lot of different types of research, but mostly clinical research.
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And then, sort of, fairing my way into health informatics.
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And I've been working on that for well over a decade, at this point.
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And I,
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have done things like write regulations at the centers
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for Medicare and Medicaid Services on the meaningful Use program.
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If you guys remember that, I've done a lot of work at the CDC on,
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developing computable guidelines, automating data exchange, and essentially
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using health IT standards to really help how we move
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information in health care and public health.
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So, that's that's more or less where my background
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comes from and feeds into what we're going to talk about today.
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Great.
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I'd like to introduce Doctor Margo McKenna.
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Margo.
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And thanks.
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I'm a pediatric otolaryngologist in Rochester, New York, at the Golisano
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Children's Hospital in Rochester, and I got involved in the guidelines
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as a GIN Scholar, which is guidelines International network, several years ago
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and then started as a methodologist in training with the Guidelines Task force.
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And then about a year ago,
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I took over from Doctor Tungkol as the chair of the Guidelines Task Force.
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Awesome.
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Thank you so much.
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Maria: what makes guidelines so exciting?
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You've devoted a lot of your
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personal career ambitions and passion towards guidelines. Why?
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Well, it's it's basically the scientific basis
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of how you treat patients in clinic in hospitals and in operating rooms.
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Basically the the sort of scientific rules,
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if you will, that are based in, in science
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that help us actually provide the care that patients need day in and day out.
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Pretty much 24 over seven 365 so what better way to, devote
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any part of a career, than to, to really, support the way that we deliver
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those, really important pieces of science into clinical care.
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And you are not an otolaryngologist.
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No. We so appreciative of you working with us as otolaryngologists to help us
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think about how we make guidelines, living and digitizing them.
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Margo.
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Doctor McKenna, GTF, Guidelines Task Force,
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demystify that in 60 seconds for our members.
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That's a good question.
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And we've been working on our website
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to to make it a little easier for people to understand
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exactly what it is that we do and what we're for.
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The Guidelines Task Force is a group of,
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people that are representatives from a lot of our sister societies.
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So someone from the American Society for Pediatric Otolaryngology,
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from the ARS Head/Neck Society of Otolaryngology.
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All of those people come together twice a year, once in person and once virtually.
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And we discuss, topics that may be eligible to become a guideline.
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So let's say, for example, someone puts a, a, recommendation
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that we should have a guideline on pediatric hearing loss, the guidelines
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group, the GTF, we'll sort of look at what literature is available out there.
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Do we have enough literature to support a guideline
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because that's a really key part of the process
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is, you know, we want these to be evidence based.
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And if there isn't evidence, then we can make something into a guideline.
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And then that GTF group will vote on how feasible it is
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and how much, you know, leverage we have to make that into a guideline.
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And if something meets a certain threshold from all of those people
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that are there in the room that it goes into our queue,
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and then eventually becomes a guideline in development.
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So as an example, that one for pediatric hearing loss is actually, coming up for
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development shortly.
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Thank you.
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And I'll say for
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our audience that's listening in our Journal Otolaryngology Head/Neck
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Surgery, the biggest impact or readership comes from our guidelines.
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Did I say that right, Doctor McKenna?
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They're really some of the most popular articles.
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And most cited articles as well. Yes. Thank you.
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That's the correct word.
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Thank you for the verbiage. Most cited articles.
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So Maria, your passion is guidelines.
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Margo explained the process and this has become your passion
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on how do we decrease the cycle time.
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Talk a little bit about Margo did a beautiful job
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explaining the process and it's a reality.
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But your work and some of your national work as well, maybe it's not a reality.
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We can do guidelines faster and perhaps better. Maria.
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Yes, well, we're trying to make it more of a reality across the board,
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across the groups that develop guidelines all the way
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through to their implementation in, in, in practice.
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So really, what, what we've tried to do is think of the entire process
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from the beginning of evidence generation all the way through to implementation
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and even beyond that, to evaluation, so that you can constantly kind of
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have this learning loop that happens, sort of this learning health system.
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And one of the things that we, we're able to figure out
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is that if you re-engineer the process to do things simultaneously
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rather than in tandem, that you would be able to actually,
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potentially cut those cycle times, to be much shorter.
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And in addition to that, if you have, or sort of co-mingle
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different disciplines like informatics and the scientific expertise
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that is usually part of a guidelines task force, you can actually have
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complementary approaches
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where the informatics person will, will really sort of
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break down the details of how a computer might need to understand
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the guidelines to really help guide again during that clinical workflow.
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While the the scientific members of the guideline task force
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can focus more on the science and then potentially, have a way to,
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to know whether their, the way that they've spelled things
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out in a recommendation is actually as clear as they think it is.
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So it's very complementary and mutually beneficial to have,
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a multiple expertise kind of working together in a given task
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force in a way that's been different than than in the traditional approach.
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Margo, when you think of the guidelines, task force,
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the work, you're continuing a tremendous legacy of leaders that preceded you.
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And, you're doing a terrific job. So thank you.
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What does that mean for us in terms of cycle time,
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working in parallel versus serial?
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We really have to go back to the beginning.
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You know, the, in the past, we've gotten through the entire guideline
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process of development.
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And then at the end, we think about how can this get translated into the EMRs
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that we use on a regular basis.
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But what Maria is talking about and what we hope to do is go back to the beginning.
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So when we start a guideline and again, this is different
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from the Guideline Task Force, which is overlooking the whole group.
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Each guideline has its own guideline panel.
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And that guideline panel starts by looking at the topic review in the literature.
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Right from that first step, we need to be thinking about
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how can we make our recommendations digitized.
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How can they be integrated into the EMR rather than trying to go back from
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the end and rework it?
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And what would that do to our cycle time?
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Or reach or impact?
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What benefit would
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our members see?
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I think our goal ultimately, and I will ask Maria to chime in too,
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is that rather
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than having this guideline at the end, we still have our pocket guide.
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That is like something that goes in your white coat,
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which obviously the younger generation doesn't use anything like that.
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We still have a printed paper copy of this guideline,
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but what we want to do is have it integrated into the EMR so that if you see
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someone that you think may have Ménière’s disease, that you're walking
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through the guideline as to like, this is the next step for diagnosis.
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We should be ruling this out. We should be getting this testing.
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We should not be getting this testing.
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And it’s right there at your fingertips, instead of having it
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be something that you have to go look up in a journal.
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And Maria, then
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am I using the right word when I say that goes to digitization?
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And you talked about coding.
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And can you talk a little bit about that with your informatics background?
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Sure.
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So the digitization really comes from, using health informatics
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to turn the words and the recommendations into something a computer can understand.
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So the EMRs that Margo mentioned and it gets incorporated
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then into the flow that is within that EMR.
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So unlike in the traditional way that you use guidelines
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where you might read a PDF or read a pocket guide or anything
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that's on on sort of a physical piece of medium, in this case
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with digitized guidelines - It not only brings the guidelines
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into that EMR so that as you're seeing the patient
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in the correct place in the workflow, ideally,
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you'd be able to see the information that you need as you need it,
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but it also actually uses that patient's data.
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So it's not even just a matter of knowing the guideline,
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but it actually, kind of, reasons that guideline over the patient's own data,
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so that when you're getting a recommendation within the EMR,
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it is a combination of the guideline and that specific patient's
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data, which gives you a more personalized recommendation to consider.
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Fascinating, Maria.
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So it takes me, a 50 year old male,
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let's say I have, Bell's palsy.
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Over a certain time frame, it would know my age, it would know my risk factors.
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It would obviously know my gender, it would know the duration of symptoms.
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Because I might have seen doctor McKenna in the office 29 days ago
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and not 21 days ago.
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And then it would help me follow that - sorry, it would help doctor McKenna.
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She's the doctor.
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It would help help her follow that.
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Correct? Based on my data.
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Exactly, exactly.
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And you know, if you think about it, there's so many guidelines out there
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that you have to, like, kind of keep in your head as a physician,
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that this this is a way to kind of have a,
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have a backup, if you will, for the guidelines themselves.
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But something that you don't have at your fingertips,
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if you will, as a physician in the clinic in the O.R.
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is really the patient's data.
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Like you'd have to go look for it, and sometimes it's not as easy to find.
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Whereas if you program the computer with the digitized guidelines,
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it should be able to find that data and kind of bring it to the forefront for you.
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So it it not only helps, again, with bringing that guideline there.
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So that you know what the recommendation is about,
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but it also tells you how it applies to the specific patient.
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In your case, you know, the 50 year old male with Bell's palsy.
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And before I go to doctor
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McKenna, Maria, you're a national and international expert on this.
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What specialties are doing it right?
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Well, different specialties are trying different things.
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I know, primary care is an area that is particularly
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ripe for something like this, since in primary care,
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those those physicians need to really think about
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a lot of different ailments that potentially could be of issue.
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And so being able to really apply this in primary care would be excellent.
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I know that
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there's a lot of surgical specialties that have really tried to do this
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in particular to help, make the, the areas
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of, of operation, especially before surgery, smooth.
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And again, potentially apply any guidelines
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that are necessary to a particular patient more easily, more easily done.
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So, those are really the, the areas that have kind of focused on it.
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But I would say that there's no one specialty that has sort of run with this.
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So we're really excited
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that you guys are so interested and hope that this actually continues
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to, to scale so that we can ultimately get these guidelines into practice
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a lot more quickly, easily, accurately, and consistently.
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Well, we're a specialty that likes to run and try and give patients great value.
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So we're excited, that you're helping us pilot this for our members.
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Margo.
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Doctor McKenna, I can think of some bad ways where digitization can go wrong.
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You could track my adherence.
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You could penalize me through payers.
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You could say that I'm overuse.
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But why don't I have you talk about the pros and cons, perhaps.
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And everybody knows how we do these podcasts.
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Nobody knows what questions I'm going to ask.
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I don't even know.
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So, Margo, I just gave
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gave you a little filler there for 20 seconds
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so you could think of a thoughtful answer.
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But but Margo, then, Maria, what are the pros and cons of digitization
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of guidelines?
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I think from the clinician standpoint, definitely
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having it at the tip of your fingers seems like it would be helpful.
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And one example that's integrated into our
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our EMR, it is for sepsis.
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A little box will pop up: “The patient has a fever and tachycardia.
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Do you want to institute the sepsis protocol?”
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So that's the kind of thing that we would be looking for.
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And it can overcome a lot of that.
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The alarm bell, you know, the way that you're you can kind of tune
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those out to bring things here, tension that you might not otherwise see.
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From the flip side, this is always been a concern.
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And it's a concern with our paper guidelines as well,
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that if there is something that's on paper that says you shouldn't get vestibular
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testing for a patient and you do it, is that something that will be eased?
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You know, you'll be held accountable for in some way?
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We do always, you know, put into the fine print.
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Each patient is different.
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These are at the doctor's discretion, at the provider's discretion
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because they're obviously they're used by, nurse practitioners and MPAs as well.
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So at the provider's discretion
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based on individual clinical factors.
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And if you can support that based on your thinking, then you know, it's
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not something that the paper guideline will be punitive in that way.
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Yeah.
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Maria, anything to add to that in a positive and negative sense?
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Sure.
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Well, the main negative, I'll start with that first, is that it's possible
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that some of these digitized guidelines could be programed incorrectly.
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Not on purpose necessarily, but that's, that's probably the main negative.
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And I, one of the,
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one of the areas that, can be challenging,
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I wouldn't necessarily call it a negative, but, in those scenarios like Margo
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just described, where it really depends a lot on the provider's perspective.
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And really they're, ability to to look at that
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particular patient and make a judgment call.
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That's not ideal in a digitized,
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guideline because it really the computer is not going to make that judgment call.
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Right? That's what the physician is there for.
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So that's probably the biggest negative.
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However, in a positive way, one of the things that this could really help reduce
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is what I call unnecessary redundancy in how guidelines are implemented.
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Most of the time these paper guidelines go out whether there's pocket
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guides or anything else like that that could facilitate
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the use of those guidelines.
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Almost always, healthcare organizations
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will take those guidelines and turn them into clinical decision support.
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Essentially, they're turning them
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into a digitized guideline within the clinical workflow in the EMR.
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But they're each doing it individually.
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So they're taking all of this time and trouble and potentially
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not necessarily, interpreting it correctly.
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So in this case, if you start with a standards
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based digitized guideline from the source of truth from
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the guideline organization, then you can put that standardized
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version out there, and each organization
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can then apply that in their own system.
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So it helps them actually take that guideline and,
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and put it into their clinical workflow in a more consistent way
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then each of them individually trying to do the same thing.
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You talked about or you're getting to the word adoption.
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How do we then work with the EMR vendors?
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The 4 or 5 dozen predominant vendors
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out there to get a digitized guideline there?
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Or do they just pick it up and who owns the IP
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and what's the national discussion on this topic?
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Well, who owns that IP is still sort of up in the air.
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I would like to think content wise it should be no contest there.
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It should be whoever's guideline it is.
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The medical society in this case, should own that.
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It, but potentially the digitized version, depending
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on who develops it, could belong to someone else.
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Each of these EMR companies should be able to take the health I.T.
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standards that are out there and apply them within their own systems.
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Some of them turn some parts of those into some of their
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more proprietary components of the system.
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But, generally speaking, the health I.T.
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standards that are out there are free to use and available internationally.
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So, those should really help get, kind of a scaled version
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of a digitized guideline out there and available
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to be implemented into individual systems.
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Yeah, very well said.
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I, I understood that, so thank you.
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And that's a testament to your ability to explain it to me.
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So thank you. That was great.
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Margo, what excites your group about digitization.
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What do you think our timeline is?
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And then I want to spend, the next segment
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of this talking about living guidelines, and I'll have Maria define that.
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Yeah, I mean, at this.
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Excuse me.
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At the past Academy meeting,
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you presented a panel about this where our staff members at the Academy
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took the Ménière's guideline and did some of this earlier digitization process.
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So they did go back to the beginning and start
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with a guideline that's already published.
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So not the ideal way
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that we want to be doing it in the future, but at least a proof of concept.
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And we're able to map out the processes that would be
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necessary and code them and digitize them.
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And then that coding, which is the specific to the guideline,
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can then get extrapolated out to the different EMR systems.
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So there's a few different steps.
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But it was really exciting
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to see that our team could do that and did do that for this guideline.
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I think that says a lot about the future, and I just give 100% credit
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to the Academy staff who are, you know,
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working behind the scenes and actually doing the work to to get that done.
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Yeah, thanks for that. Shout out.
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The Academy staff under Research and Quality, very passionate about this
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and have really made it, a feather in the Academy's cap to deliver member value.
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So very well articulated there.
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So let me just make a facetious statement.
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So digitized guidelines are not just a PDF thrown there in the EMR.
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It's actual digital coding and logic and algorithms.
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Correct.
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Yeah.
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And as you said Maria, that's where some of the IP is there.
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Because by developing that logic and algos there is value there.
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Yeah.
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So the algorithms, again represent the written,
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guideline, the narrative guideline that the guideline panel, develops.
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So there's there's still that question of where the IP actually, remains,
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but the digitized versions should use health I.T.
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standards that again, are free to use to anybody.
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So in that sense they're not necessarily IP that,
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that has a copyright that only the EMR vendor owns.
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However, all of them should be able to leverage it.
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Margo, please.
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I was just going to use an example that Maria came up with
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that really helped me understand it, because coming from a clinician's
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clinician standpoint, I don't always have all the I.T.
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background, but it's like going from a paper map,
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which is our written guideline,
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to something that's like a GPS that's on your phone.
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So people don't even ask for directions anymore.
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They just put the address in and the GPS takes you right where you're going to go.
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So that's what we're trying to get from the paper map to the fully
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implementable digitized version.
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And then let's take that analogy one step, more granular.
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And then the old school was when you would go to Google Maps
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and you would print it out, and then you'd have that print out in your hand.
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And Maria, that's what I think you're talking about.
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We're moving towards digitization, but we don't want to fall
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into this valley of death where we think printing something out is digitized.
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No, no, no.
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Correct.
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So a PDF is not a digitized guideline.
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It's essentially a paper guideline that you can see it on your computer.
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Really well said.
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When you used to print it out on Google Maps, it was still a printed map.
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It just came from your computer.
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So living guidelines, who want to take a stab at that?
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Because when I told people we were recording this podcast, they said,
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oh, great, you're going to talk about digitization and living guidelines.
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So we address digitization, but living guidelines.
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Who's going to start there?
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I can start with
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what are the processes now for our updating her.
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Right.
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The guideline takes about 18 months
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to have the panel together do all the searches,
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you know, collate the evidence and,
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and come up with the key action statements and get it published.
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Every 5 to 10 years, those ideally should be updated,
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meaning we go back and we rereview the literature.
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We add things that weren't there before and we publish it again.
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Even the update takes at least a year, if not a little bit longer.
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The more guidelines we publish, the more updates
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we have to do, and it becomes an untenable situation
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where we just don't have the bandwidth to do that.
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So one thing that we are trying to do are trying to move
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slightly toward, because it's a huge process
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or project, is to make the guideline more of a living document.
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Very well said.
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Maria, wouldyou like to add to that?
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That was beautifully stated.
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Yeah.
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I mean, the main thing I would add to that is on the digitized side,
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there's ways to to take the components of the algorithms and update
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just those components and then test them to make sure
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they're not affecting other parts of the algorithm.
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So there are ways to apply a living guideline
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approach in the digitized version too.
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Exactly, Maria, and I just wrote that there's kind of this interplay.
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If we have living guidelines, digitization accelerates that.
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It's it's almost, accretive or it's a multiplier effect.
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Exactly.
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Margo.
23:36
One thing, too, about having it in the EMR is
23:38
we can see what people are actually doing.
23:40
You know, right now, if the paper guideline is out there,
23:42
we don't know who's following that.
23:44
We don't know if anyone's following it or even reading it, other than downloads.
23:48
But if it's in the EMR, we can see, you know, how many clinicians actually did X,
23:53
Y, and Z, and that can feed back to the guideline, to the guideline
23:56
development process and say, like 90% of physicians are already doing this.
24:00
Do we really need to revamp the whole thing?
24:04
And there's a huge potential
24:05
as a separate topic for AI to to be helpful with this, too.
24:09
I think people are carefully wading into those waters of, you know, could
24:12
could I be helpful in reviewing the literature or summarizing
24:16
some of the newer papers that have been published
24:19
in the last 5 or 10 years to present that to the clinicians
24:22
who can then go through and decide if a if an actual huge update is needed.
24:27
Yeah, I coded in high school and a little bit in college.
24:31
So let me make this an if then statement and impress you with my my coding words.
24:37
So if medical knowledge
24:41
evolves every 3 to 5 years,
24:44
then an 18 month cycle time
24:47
and a 5 to 10 year cycle time is absurd.
24:50
And I mean that just respectfully. Right.
24:52
And I know, you know that Margo and Maria and our committee members know that.
24:55
But that's all they've been had paper processes
24:59
sending documents back and forth.
25:02
So talk a little bit about the exciting, exciting potential,
25:05
Margo and Maria of digitization, helping living guidelines
25:09
with an Academy partner, open evidence or with other kinds of tools.
25:15
You said all the words of all the things that were trying
25:17
and attempting to put together.
25:19
And if you look across the world, some places are doing this,
25:24
but it's still very, resource intensive.
25:28
Exactly.
25:28
So, I think there's still a lot of barriers to overcome, but
25:32
ideally, yes, we would have the evidence and it would be in a guideline
25:37
right away so people can use it if it's good evidence.
25:39
And we're just not there yet.
25:41
Yeah.
25:41
And I use the word absurd in a joking sense because it is reality.
25:46
It is so hard to get it right, to get a 40 to 50 page document right.
25:51
And Maria spoke a little bit about AI or technology
25:55
and your biggest fear something gets coded wrong.
25:57
Our biggest fear right,
25:59
Margo, is if we use an algorithm or do something to accelerated.
26:02
We hurt a patient. Never, never want that to happen.
26:05
Maria, bring us up to speed on those discussions.
26:07
What are some of those national discussions
26:09
regarding living guidelines and cycle time of medical knowledge?
26:12
So and I'll just add that what you said about the hurting patients,
26:16
that is the the main concern with coding something wrong.
26:20
You don't want the wrong recommendation to, happen
26:23
and then be followed in that case and then caused harm.
26:26
So, what we want to be able to do, though, in the case of living guidelines
26:30
especially, is be able to, once you've implemented a digitized
26:34
guideline almost, incrementally be able to update it based on any new evidence
26:40
that affects some portion of a guideline, like one recommendation, for example.
26:44
And and that way you can update something like an age range
26:47
that might have changed or an additional test
26:49
that's needed, or maybe one fewer test that's needed or whatever the case may be.
26:53
That should be a relatively easier change
26:56
than having to re-implement a new guideline every 5 to 10 years.
27:01
Or a guideline update, some somewhere more frequent than that.
27:05
So it's,
27:06
it's definitely an approach that should ultimately cut down the cycle time.
27:10
And what that really means for patients is that the most up to date
27:14
scientific evidence can get to them faster.
27:17
Very well said.
27:18
And Margo, we know from our colleague,
27:20
Doctor Cecelia Schmalbach, the editor in chief of our journal,
27:24
there has been an asymptotic rise in scientific literature.
27:28
It's humanly impossible to get our head around it.
27:31
We probably could in the 90s and early 2000,
27:34
but it's now amazing how technology's coming together to help us.
27:39
We never could have had living guidelines before.
27:41
Margo, do you want to talk about that?
27:43
The evidence burden is just exploding.
27:46
It's it's huge.
27:47
And it is, you know, the guidelines.
27:50
The chair of the guideline is a surgeon, clinician.
27:54
And in some areas, they have the the chair of the guideline
27:58
be responsible for kind of surveilling the evidence over time.
28:02
That's
28:02
I don't think that's realistic to expect someone to be surveilling the evidence.
28:06
So you know, we are lucky they have the Academy staff that can help us with this.
28:10
We have a search strategist who is, not who is outside of the Academy,
28:15
to help our clinicians so that we can use our medical knowledge
28:20
and resources to the kind of vet through it, but not be responsible for,
28:26
you know,
28:26
reading every paper that comes through the journal, it's, it's a lot too much.
28:31
And again, I there's a potential for that to help as well. But.
28:35
Well let's spend maybe a couple minutes on that Maria.
28:37
Let's talk about the potential for augmented intelligence.
28:40
Artificial intelligence, large language models.
28:44
What do you see Maria and then Margo as optimism?
28:47
You've talked about the caveats
28:48
but how will this help us in the next couple of years
28:51
as we accelerate living in digitized guidelines?
28:55
Well, there's definitely research going out there to to see how consistent,
28:59
these large language models can be in using AI
29:03
for different components of the, guideline development process.
29:06
Margo talked a lot about the evidence portion.
29:09
I think that's probably the most, far ahead then.
29:12
Then some of the implementation or even guideline development aspects,
29:17
that it can that constantly be looking for updates in the literature,
29:20
for example, it could summarize that, literature, it could help provide,
29:25
maybe a beginning summary of, of
29:30
what's out there
29:31
and how it potentially could apply, into guideline recommendations,
29:36
where I know there's research out there looking into how it could potentially
29:40
then leverage that evidence in conjunction with, health I.T.
29:45
standards to, to put, draft recommendation, a digitized recommendation
29:50
out there.
29:51
And that's again, nowhere ready to be, ready to go live.
29:55
But, that's some of the areas that that are being looked at in terms
29:59
of the development side.
30:00
On the implementation side, there could be ways that I could be used
30:04
to help take a standards based, digitized guideline and implement it
30:09
into an individual system based on, for example,
30:12
like an epic platform.
30:15
They, you know, they would be able to, apply the AI to the standards
30:21
and then incorporate it into the workflow of that EMR.
30:24
It could potentially also help, even within the clinical workflow
30:29
and augment based on information that's being input for, for a patient.
30:34
So some of that patient's data could be applied
30:37
in ways that I can help sort of augment or facilitate
30:41
what the clinical decision support algorithm is doing within the workflow.
30:45
So all of these things
30:46
are being researched right now and, and trying to see how consistent
30:50
it can be without producing things like hallucinations that we hear about,
30:54
which would definitely not be, not be good for patient care.
30:59
Yeah.
30:59
Margo, what what future do you see as a clinician with AI integration?
31:03
We've talked a little bit about it.
31:04
I ask, you know, what are your med students have in their white coats?
31:08
Remember what we used to have?
31:10
We had Harrison's.
31:11
We had our stethoscope, we had our K.J.
31:13
Lee. Right. Our white coats were full of stuff.
31:16
But your med students, what's in their white coats?
31:18
And what do you see as AI from a clinical perspective with guidelines.
31:22
Is is completely changed, you know, from all the little paper books that we had.
31:27
Exactly.
31:28
I, I have been using open evidence a lot.
31:31
I think that that's, you know,
31:32
just scratching the surface of what's possible, but it's so helpful
31:35
in the way that it's it's smartly presents the evidence to you in a, in
31:39
a summarized way.
31:41
So I think
31:42
there's a lot that's exciting coming up,
31:46
but hard for me to know which direction.
31:49
Yeah. You mentioned the Academy staff.
31:51
Can you talk a little bit about your volunteer cadre?
31:54
I think the guidelines task force is about 25, folks.
31:58
And then how many folks are involved with the panels?
32:01
I'd say they're about a 100 plus otolaryngologists that are involved
32:05
with the laborious process and the high integrity
32:08
process of guidelines in my right in that, Dr McKenna?
32:11
Correct.
32:12
And there are there's a group of about, 5 to 10 methodologies and methodologies
32:17
and training who kind of help steer the guidelines in the right
32:20
direction, make sure that, separate from the content.
32:23
But just make sure those that we're following our process each time
32:26
and, those people will do multiple guidelines back to back.
32:30
And same with the Academy staff who are, there
32:33
to kind of help facilitate the entire process and keep us on track.
32:37
And then all of the physician volunteers.
32:39
And that's not only otolaryngologists, but for, for example,
32:43
the sinusitis update that we just did has someone from infectious disease,
32:47
someone from allergy, you know, so it's a multidisciplinary,
32:50
always a patient advocate.
32:52
Usually someone that is either a nurse
32:54
or, nurse practitioner who provides some input as well.
32:59
Maria, we're going to end with you.
33:00
But before I do that, Margo,
33:02
we're both pediatric otolaryngologists, so we see kids and development.
33:06
So somebody wants to grow up to be doctor McKenna.
33:09
They want to be chairwoman of the guidelines task force.
33:11
How does that happen?
33:12
What's been your path and what
33:15
what, guide or mentorship
33:18
do you give to those that want to be in what you do one day?
33:22
I think there are two, two key things
33:24
as a young attending or a resident or fellow.
33:28
One was, if you are on an Academy committee,
33:31
then you have a high likelihood or at least a chance
33:33
of getting on a guideline panel, which is one of the first steps,
33:36
because usually we will send out, a solicit
33:40
from all the different committees
33:41
who are relevant to that guideline to send us a panel member.
33:45
And that's how I got involved from the Pediatric Otolaryngology
33:47
Committee, onto the guideline panel
33:50
for Epistaxis, because I started at age two.
33:53
That guideline is specific down to age two.
33:55
And the second thing was the Cochrane GIN Scholars Program,
33:59
which is through the Academy.
34:00
So applying for that fellowship program, which is has been really,
34:05
such a great program over the years to get people involved in,
34:08
systematic reviews, the guidelines, and then those people
34:13
sometimes will pull them in as,
34:15
leadership for the guidelines, chairs, assistant chairs.
34:18
Thank you for that.
34:19
So we can all grow up to be like Doctor McKenna if we started a committee.
34:23
Thank you for your service and friendship over the decades.
34:26
Maria, why don't you end us with a blue ocean?
34:31
So you've devoted your whole career to this, putting together
34:34
biology, sciences, medical informatics, public service.
34:38
You do this on your volunteer time.
34:39
And so we're so appreciative of you.
34:42
What does the blue ocean look like?
34:43
Bring it home.
34:44
When somebody sees your family member or sees you, what do you
34:47
what do you see out there? Maria.
34:49
Well, ideally, a patient
34:51
won't even know that there's something in the EMR helping guide things.
34:55
In fact, maybe the clinician shouldn't know either.
34:58
It's just that seamless.
34:59
So in an ideal world, there would be this kind of seamless aspect
35:03
that just helps but doesn't impede, what's happening in clinic
35:07
or in the operating room or in a, in a ward in the hospital.
35:12
So, that's on the sort of user end of it.
35:16
On the, back end of it.
35:18
Ideally, we'll get to a point where
35:20
maybe we do figure out how AI can really enhance the ability
35:24
to digitize the guidelines and get them into those EMR workflows
35:28
in a way that ultimately creates that seamless experience,
35:32
that we are able to cut those, cycle times down.
35:36
I think the number still out
35:37
there is an average of 17 years to get scientific evidence into practice.
35:41
That is entirely too long.
35:43
We really should be able to cut that down into much, much shorter, cycle times.
35:47
And ultimately, like I said, get that, scientific evidence
35:50
that up to date, cutting edge scientific evidence into practice,
35:54
into patient care much more easily, quickly, accurately and consistently.
35:59
One of my favorite phrases is ten x.
36:02
We always want to multiply.
36:03
And so 17 years, Margo, you're going to regret me learning this
36:07
because now I'm going to say 1.7 years, you know, and I think we'll get there.
36:11
Don't you think Margo and Maria?
36:13
I do. It's really exciting.
36:14
I do think we're on the way to getting there.
36:17
I want to thank you both, for getting me excited and our members
36:20
excited, educating us about the guidelines development process.
36:23
Very important.
36:24
We all use the guidelines in our practices.
36:27
Again, they’re our most cited articles, our most read articles.
36:30
But here we talked about how we make them living and digitized.
36:34
Maria. Margo.
36:35
Thank you both very much
36:36
for carving this time out of your day to educate our members. Thank you.
36:40
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36:42
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36:47
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36:49
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36:56
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