"Increasing pressure is being exerted on health care organizations to maximize quality of care while containing costs. There is a general appreciation that clinical decisions must be based on evidence (medical knowledge derived from research findings) to a much greater degree than they have been in the past and this has helped provide impetus to the current drive towards evidence-based care (1). Clinical decisions should combine three factors; scientific evidence, socio-ethical values,, and resources. However, many are still based principally on values and pay little attention to evidence derived from research, the scientific factor, and to resources, the economic factor. This is changing: decisions are having more and more to be justified explicitly and publicly.
"Clinical practice guidelines can facilitate us to achieve such strategic goals. However, the development of good guidelines does not ensure their use in practice. Reviews of the effectiveness of various methods of guideline dissemination show that it can be achieved when guidelines are made accessible through computer-based patient specific reminders that are integrated into the clinician's workflow.
"A further dimension of the problem of guideline dissemination and implementation in health care organisations needs to be considered. The individual doctor-patient relationship is being replaced by one in which the patient is managed by a team of health care professionals, each specializing in separate aspects of the care process. This 'shared care' depends critically on the ability to share patient-specific information and medical knowledge easily among care providers. Indeed, it is the present inability to share clinical practice guidelines across systems and organizations that represents one of the major impediments to progress towards effective evidence-based care. Strategically, there is a need to take a more clinical process view of health care delivery and to identify the appropriate organizational and information infrastructures to support the process."