Post on 12-Apr-2017
Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century
EMPOWERING CLINICAL LEADERS
Dr Lalit Singh, M.S., FIAGES, MBADirector Content and Product StrategyElsevier Health Solutions
Life of a physician in 2016 From an era of lack of information to that of information overload!
Why talk about Clinical Decision Support ?
Provided all the correct inputs in a complex scenario, a machine is likely to make better decisions than an individual
We are all trying toINCREASE THE VALUE ofour health & healthcare…
Value = Quality/Cost
So, what are we trying to achieve?
Improve Patient Outcomes
Control the Costs of Care
Maximize Patient Throughput
What Stands in the Way?
VARIABILITY
Variable Cost, Quality, Efficiency Uniform Cost, Quality, Efficiency
VARIABILITY IN HEALTH & HEALTHCARE DELIVERY DRIVES DOWN QUALITY, DRIVES
UP COSTS,AND REDUCES PATIENT THROUGHPUT
The Damage Caused by Variability in the Delivery of Healthcare…
400,000 PREVENTABLE DEATHS ANNUALLY
10,000 PREVENTABLE SERIOUS COMPLICATIONS
DAILY
12,000,000 AMBULATORY DIAGNOSTIC ERRORS, 50% POTENTIALLY SERIOUS
Data from The US
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In the high risk airline industry, reduced variability is the cornerstone of customer safety.
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Henry Ford
His creation in 1913 of the assembly line revolutionized the manufacturing across the globe, dramaticallyincreasing productivityand reducing costs…
Reduced variability was a critical feature of Ford’s high efficiency assembly line.
So how do we UNIFORMLY & SUSTAINABLY
REDUCE VARIABILITY IN HEALTHCARE DELIVERY
to decrease the cost and increase
the quality and productivity of our healthcare system?
CLINICAL
DECISION
SUPPORT
Solutions which empower providers & patients with current, credible, evidence-based and evidence-informed guidance
C
D
S
An Electronic Medical Record
IS NOT
in-and-of itself a
Clinical Decision Support solution!
An EMR is an efficient, consistent
way to deliver CDS solutions
to physicians, nurses, pharmacists, other traditional
care providers, and to patients.
The key to better adoption of HIS among physicians is to give them a compelling reason to do so!
How do we ensure our clinicians adopt Clinical Decision Support?
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Different types of Clinical Decision Support (CDS)
• Information support delivers passive content which the user has to interpret
• Action rules commonly used to deliver alerts and reminders
• Computer-Interpretable Guidelines (CIGs) provide active decision support that:
Customises content to each patient
Uses data from electronic medical record when this is available
Is associated with improved outcomes
Actively interprets guidelines in the light of patient data & prompts if more data is needed
Simplifies content by automatically customising the guidelines appropriate for each patient journey over time
Presents personalised reasons for options, with arguments for & against
Records decisions selected & tasks performed, along with variance tracking
HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,
GOALCLINICAL DECISION SUPPORT STRATEGY
FOUNDATION
HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based ContentMinimally Disruptive to Provider Workflow
Rapidly Delivered to All Points of Patient CareHelps Record and Analyze Clinical Data for Providers and Policy Makers
HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based ContentMinimally Disruptive to Provider Workflow
Rapidly Delivered to All Points of Patient CareHelps Record and Analyze Clinical Data for Providers and Policy Makers
PHYS
ICIA
NS
NU
RSE
S
Oth
er C
are
Prov
ider
s
PATI
ENTS
PILLARS
Pull
Push
SOLUTIONS
“Pull” CDS solutions allow care providers to seek out and consider current, credible, evidence-based information and guidance…
“Push” CDS solutions force care providers to consider current, credible, evidence-based information and guidance…
The combination of “Push” and “Pull” CDS solutions
most empowers all 4 providers
HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based ContentServes All Major Care Provider Types
Rapidly Delivered to All Points of Patient CareMinimally Disruptive to Provider Workflow
PHYS
ICIA
NS
NU
RSE
S
Oth
er C
are
Prov
ider
s
PATI
ENTS
SOLUTIONS
HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based ContentServes All Major Care Provider Types
Rapidly Delivered to All Points of Patient CareMinimally Disruptive to Provider Workflow
PHYS
ICIA
NS
NU
RSE
S
Oth
er C
are
Prov
ider
s
PATI
ENTS
ORDERSETS(push)
REFEREN
CE(pull)
CAREPATHWAYS(push & pull)
CAREPLANNING(push & pull)
REFEREN
CE(pull)
eLEARNIN
GSKILLS
LMS(push & pull)
CAREPLANNING(push & pull)
REFEREN
CE(pull)
eLEARNIN
GSKILLS
LMS(push & pull)
CAREPATHWAYS(push & pull)
ENGAGEMENT&
EDUCATION(push & pull)
COMPLETE STRATEGY
ELSEVIER
Over 25% ofthe World’s
Clinical Content Serving over 20M healthcare
professionals
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Elsevier’s Mission: Moving Knowledge into Practice
The intersection of trusted content and workflow-friendly solutions
• Over 100 years of trusted content • Deep expertise across all forms of
clinical content
• Solutions centered around clinical workflows
• Partnerships to ensure integration of content with technology
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ELSEVIER
Order Sets
Radiology& Pathology Reference Solutions
Physician Reference Solutions
Nursing Reference Solutions (Generalist and Specialist)
Clinical Skills for Nurses
Patient Engagement
Clinical Pathways
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Elsevier suite of applications supported by the World’s Best Content
Patient Focused
Radiology & pathology reference and CDS solutions
Easy to work with, user friendly ambulatory order sets
Personalised care pathways Impactful “low value” and “risk” alerts
Physician & pharmacist reference and CDS solutions
Customizable, multi-language & literacy level patient education solutions
The most powerful patient data collection solution
Nursing Skills, eLearning, learning management systems, reference & Care Plan Solutions
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Physician reference
Care PlansDrug information
Pharma reference
Nursing referenceNursing education
Patient engagement
Order sets
You
Non-integrated, non-communicative individual products fail to communicate or integrate and often provide conflicting guidance!
• More Costly• Too Many Contacts• More IT Challenges
WHY “BEST IN CLASS” PRODUCTS CAN’T DRIVE VALUE…
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• Less Costly• Fewer Contacts• Simpler IT
Physician reference
Care Plans
Drug information
Pharma reference
Nursing referenceNursing education
Patient engagement
Order sets ITERATIVE solutions that COMMUNICATE, INTEGRATE, and provide CONSISTENT guidance!
“BEST IN SUITE” SOLUTIONS DRIVE VALUE.
The problem has been with integration of our best in breed applications
Dr Mammen, CMC Vellore
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Building blocks of Arezzo guidelines
•Arezzo computer-interpretable guidelines (CIGs) are made up of• Tasks and collections of tasks• Data Items•Tasks and data items have attributes• Define the behaviour of the guideline during enactment by Arezzo Performer
•Arezzo has four basic types of tasks• Enquiries; Decisions; Actions; Plans• CIGs are made up of collections of these four basic types• Keystone is the parent type, which is used to link CIGs together
•
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Thank You!