Practice guidelines and the emperor's new clothes.

Clinical guidelines are problematic because it is difficult to get people to follow them, effective mechanisms are usually not in place to determine guideline compliance, and the belief that guideline compliance is associated with higher clinical quality or lower cost is usually based on faith rather than data. These issues can be addressed by combining practice guidelines with outcome research and clinical information system technology which can result in a method to track adherence to and variance from guidelines; determine the effectiveness of guidelines in improving quality and decreasing costs; and create a dynamic system for guidelines development and differentiation based on empirical results related to which guidelines and variations are most effective for different types of patients.