Partnership for Policy Implementation (PPI)
The Partnership for Policy Implementation (PPI) was established to increase the ability of pediatricians to implement AAP recommendations at the point of care. PPI operates by assigning a medical informatician/pediatrician to work with the lead author(s) and/or guideline subcommittee to help produce clear guidance on how pediatricians can implement recommendations in practice. PPI also works to ensure that AAP recommendations can be easily incorporated within electronic health record (EHR) decision support systems.
The PPI Program:
- Helps guideline committee or policy author(s) incorporate implementable language into recommendations so they are actionable, decidable, and executable.
- Works to develop an algorithm that will define how recommendations or key points are to be carried out at point of care (where appropriate).
- Identifies and clearly defines key terms and assure consistent language within the policy.
- Establishes and builds upon a common pediatric language for information-management systems which will allow health information technology (HIT) systems to be integrated and interoperable.
Disambiguation: When non-specific language is used in a statement, HIT developers are left to interpret the meaning, which leads to differences in implementation. For example, the use of the word “infant” (what’s the age range for an infant?) or the phrase “low maternal education” are ambiguities that are difficult to encode within a system. The PPI works to disambiguate non-clear language and to substitute specific, common, and well-defined pediatric language.
Clear Definitions: Given that domain experts are most commonly authors of policy statements, clinical reports, technical reports, and clinical guidelines, PPI helps to identify when these documents are written with definitions or concepts that non-experts might find to be unclear. For example, when providers are asked to perform developmental surveillance at every visit, a full explicit definition of the meaning of surveillance should be included.
Clearly Defined Logic: When provider action is prescribed, it needs to both be explicit and detail all potential possibilities. By clearly and completely defining the logic, HIT developers can build alerts, reminders, and decision support tools to facilitate task completion by clinicians.
Implementation Techniques: The PPI recognizes that statements for standards-of-practice have the potential to define exactly how actions and behaviors should be performed. For example, the standard for developmental screening can be clarified to state whether it can be conducted with a standardized instrument before a visit, or whether it should be completed by the provider in the office. By providing this specific information, functional standards for EHR software can be established and disseminated to developers for incorporation into workflows.
Action-Oriented: Through the use of tools like clinical algorithms, the PPI aims to help create policies and guidelines that communicate how clinicians should behave. The goal is to make recommendations action-oriented so that clinicians and technology developers have a better understanding of how to fulfill the intent of the statement.
Transparency: The PPI seeks to prescribe documentation and rational for specific clinical actions. By clearly defining the level of evidence supporting each course of action, the provider is given the tools by which to use professional judgment to make a decision at the point of care.
HIT Standard Development: Once clear, more concise statements are created, they have to be “matched” to the various vocabulary, logical, and functional HIT standards (eg, LOINC, SNOMED, RxNorm, etc). This process will ultimately lead to a common pediatric language for information-management systems. These public domain products allow HIT systems to be integrated and interoperable with each other. These efforts also assure that the national HIT framework supports the medical home approach to pediatric care, enabling the provision of coordinated, comprehensive care to all children and their families.
Recent PPI Projects
Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years
- Supplemental Information: Standard Terminologies and Pseudo-Code
- Supplemental Information: Key Action Statements Displayed as Production Rules
- Supplemental Information: QDS Listing of Decision Variables and Actions
Stephen M Downs, MD FAAP - Chairperson
Christoph Lehmann, MD FAAP
William Adams, MD FAAP
Aaron E Carroll, MD MS FAAP
Alex Kemper, MD MPH MS FAAP
Richard Shiffman, MD FAAP
Andrew Spooner, MD MS FAAP
Eneida Mendonça, MD PhD FAAP
Stuart Weinberg, MD FAAP