Technical standards and practice guidelines: should we? Why now? Why SNIS?

and designed to assist both patient and provider in decision-making about the clinical circumstance that they may en- counter. Where possible, clinical practice guidelines are statements of best practice that should be based on outcomes data of the treatments we employ. In 1989, Congress mandated the crea- tion of the Agency for Healthcare Policy and Research. This agency was given broad responsibility for supporting research, data development and related activities. At the same time, the National Academy of Sciences published a document indicating that guidelines are expected to enhance the quality, appropriateness, and effectiveness of healthcare services. While such con- clusions might appear to be self-evident, one could argue that these goals have not been validated in actual practice. As data accumulate on the effect of EBM, proof of outcome improvement must be demon- strated just as we would expect with any new drug or device. When outcomes data are not robust,