Background: Low back pain (LBP) is a complex health care issue that often involves multiple providers across various care settings. Health information technology holds promise to improve care delivery by providing infrastructure for communication, clinical documentation and management of patient data. Standardised terminology is essential for interoperability and enables evaluation of clinical data generated by documentation in an electronic health record (EHR). Objective: The purpose of this study was to demonstrate the feasibility of mapping evidence-based practice (EBP) for conservative management of LBP to the Omaha System and foster inter-professional communication and collaboration among diverse practitioners and patients. Methods: EBP guidelines for non-invasive treatment of LBP were mapped to the Omaha System using a clinical expert approach with attention to content feasibility, linguistic validity and granularity of terms. Results: A clinical guideline for LBP management was developed consisting of 13 interventions for pain and neuro-musculo-skeletal problems. The most common intervention categories were case management followed by treatments and procedures, teaching, guidance, and counselling and surveillance. Scope of practice overlap was identified among primary care, chiropractic and physical therapy practice. Conclusion: Use of the guideline may facilitate clinical documentation using the Omaha System for LBP management and has potential to generate meaningful data to evaluate clinical effectiveness and promote quality research. The use of encoded EBP evidence within an EHR can increase the use of available evidence, enable interprofessional communication, improve quality of care, and enhance the usability of data across care settings.
- Electronic health record (EHR)
- Evidence-based practice (EBP)
- Low back pain (LBP)