Post on 11-Aug-2015
Knowledge Translation & Care Pathway Optimization Using Mobile and Web Based ToolsDaniel Schwartz, MDJune 18, 2013
Objectives
Learn about the impact of a web-based patient management tool that helps health care professionals adhere to best practices while collecting useful administrative & CQI data
Become familiar with the impact of mobile apps for smartphones and tablets that can be utilized to access decision support tools and personalized reference materials at the point of care
Full text: http://qxmd.com/r/10793162
Medical literature is constantly being published
Landmark clinical research, if adopted and put into practice by healthcare practitioners, has the capacity to save lives
Medical Literature as a Source of Knowledge
HCPs may not stay up-to-date with landmark clinical research
It often takes years for the latest best-practices to be integrated into a physician’s practice
The Problem
Barrier to Discovery 1,000s of Medical Journals; each journal publishes
hundreds or thousands of papers/year Difficult to separate the wheat from the chaff
Barrier to Access Content hidden behind paywalls University and hospital site licenses still require extensive
effort to navigate
Why?
Personalized Medical Journal
Use combination of crowdsourcing, data feeds, aggregated behaviour analysis to display content important to the user
Navigate institutional access and site-licenses seamlessly
http://qx.md/read
Read by QxMD
Traditional Access Method Using ‘Read by QxMD’
• Search for paper of interest
• Click to view• Paper behind paywall?
• Navigate to institution for institutional access
• Login• Search for paper• Find and select paper in
search results
• Estimated Time: ~ 5 min
• Discover paper of interest• Tap to view• Heal the sick
• Estimated Time: < 20 seconds
Comparison
Accessing a Paper
Save >100K lives per year just by doing what we already know we’re supposed to do1
Impact
1To Err Is Human: Building a Safer Health System. Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press; 1999. ISBN: 9780309068376.
Full text: http://qxmd.com/r/21482743
Simple Tools Make Big Differences
“Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines.”
Durieux et al. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med. 2009 Nov 17;151(10):677-86.
Full text: http://qxmd.com/r/19920268
Checklists
A simple safety checklist (the Surgical Safety Checklist) in the operating room can significantly reduce post-operative complications.
Specifically, death after surgery was reduced by more than 40%.
Impact of Clinical Decision Support
Decision support systems can improve clinical practice
But, up to 30% of systems don’t have any meaningful impact
Kawamoto et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330
http://qxmd.com/r/15767266
Peritonitis
Peritonitis Tracking & Management Solution Tracking = Data Management = Clinical Decision Support
Technical aspects
Web-based application hosted in the cloud (“cloud computing”)
Written in Perl, HTML, JavaScript, and CSS >10,000 lines of code
MySQL database for data storage
Open source – on Github github.com/renalconnect/RenalConnect
Protocolized care
Patient presentswith peritonitis
Start antibioticsempirically, send PDfluid ± swabs forculture & sensitivity
Follow-up cultureresults, then modifytreatment
Repeat culture at end ofantimicrobial treatment toconfirm clearance
Organize home visit,patient education toincrease chance ofperitonitis-free PD
Continue ongoingregular follow-up
Accomplishments | Peritonitis Rate
2008 1:20
months
2009 1 :21.5
months
2010 1:26.6 month
s
2011 1:30.6 month
s
2012 1:34
months
Google Glass in Healthcare
Anatomical landmarking during procedures Assistance with access canulation
Listen in to the conversation Semantic analysis of speech Auto-suggest differential diagnosis, phone numbers, drug
dosing
View patient results at the point of care
Rounding in the HD unit
Past medical history
Acute issues to follow up (eg investigations, referrals, BP/goal weight, etc)
Pending appointments
Chronic issues Transplant status (referred? If no, why?) Access (line? If so, why?) Code status (what is it? Documenting ‘Full Code’?) Plans for home dialysis? “Right Start” action items