The Next Generation of Clinical Decision Support (CDS) · 7 UpToDate is the number one online...
Transcript of The Next Generation of Clinical Decision Support (CDS) · 7 UpToDate is the number one online...
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The Next Generation of Clinical
Decision Support (CDS)
Pilar Hermida, Director
UpToDate
15th January 2015
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PART I: What is CDS?
• Clinical Decision Support (CDS): Definitions
• Clinical Decision Support (CDS): Impact
PART II: Future of CDS
• Business Trends
• Workflow Integration & Access Options
PART III:
• CDS: Considerations for Estonia’s e-Health Plan.
Q&A
Objectives
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First, a Story:
The Night mHealth Saved a Life
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The Night mHealth Saved a Life
• Obstretician-Gynegologist was called in at 3 am.
• Patient in massive shock post-partum
• Common maneuvers were not working
• Rarely performed emergency measures needed
• Doctor was not familiar with them
• What happens next?
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UpToDate.!
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The Night mHealth Saved a Life
• Conducted a search on UpToDate: Surgical techniques were
“perfectly and efficiently described.”
• “I read them aloud to the surgical team.”
• “Within 5 minutes I was performing the exact maneuver
described in the text.”
• “It worked perfectly. The patient's life was saved by that
maneuver.”
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“…a life I was able to save thanks to immediate access to UpToDate on my cell phone.”
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Doctors Have Clinical Questions
Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218;
Osheroff, JA. Ann Intern Med 1991:575; Ely, JW. J Am Med Inform Assoc 2005; 12:217;
Gorman, PN. Med Decis Making 1995; 15:113.
Unanswered clinical questions
impact patient management decisions
Approximately 2 out of 3 clinical
encounters generate a question
Physicians have approximately
11 clinical questions a day
60% of questions
go unanswered
Answering all clinical
questions could change
5 to 8 patient management
decisions each day
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Clinical Decision Support (CDS)
Definitions
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UpToDate is the number one online evidence-based
clinical decision support system in the world that helps
doctors answer their clinical questions at the point of
care.
Our 5 700 physician-editors from 51 countries (the top
experts in their fields) synthesize the most recent
medical information in evidence-based practical
recommendations to:
Find quick answers to point-of-care questions
Save doctors’ time
Improve medical education
IMPROVE OUTCOMES AND QUALITY OF CARE
What is UpToDate?
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10 000+ Clinical topics
1500+ Patient topics
28 000+ Graphics
140+ Medical calculators
380 000+ Evidence links
What’s New/
Practice Changing
Updates
22 Specialties
CME/CPD
5 100+ Drug entries
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A New Way to Practice Medicine
5 700+ Physician authors
CHANGE IN MEDICAL PRACTICE
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Option 1: UpToDate Search Box
9
Best
Practice!
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UpToDate search page accessed via a link
User clicks on “UpToDate” button/icon, menu option, etc.
From toolbar at top of page or from menu
UpToDate Search Box is preferred method (Option 1 - previous slide)
Option 2: UpToDate Link
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Menu/List:
Toolbar:
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Option 3: UpToDate Targeted Search
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Obtain clinical information for medical term displayed on EHR page
Single-click access is recommended for quick decision support
Versus right-click or drop-down, or Icons within a table/list
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A Trusted Resource
21+ years For 21+ years, the most trusted evidence
based, peer reviewed editorial content,
proven to improve patient care quality
5 700+ authors Expert evidence-based recommendations made by
over 5 700+ physician authors from 51 countries
850 000 clinicians Over 850 000 clinicians and 29 000 hospitals
worldwide in 164 countries rely on UpToDate,
including: 95% of medical teaching institutions in Benelux and Germany
90% of medical teaching institutions in Japan
90% of medical teaching institutions in the United States
250 000 000+ searches Clinicians view more than 250 million topics
annually in UpToDate, changing 80 million clinical
decisions
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Find Answers Faster
Patent translation technology
with:
9
Search in
languages Auto complete
Customized
default language
Navigation
Translation
feedback
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Clinical Decision Support (CDS)
Impact
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Research Demonstrates UpToDate Impacts Outcomes
We invite you to review the study data yourself: http://www.uptodate.com/home/research
Over 60 research studies
UpToDate is the most widely
studied point of care clinical
decision support tool. To
date there have been over
60 studies that have studied
UpToDate as a tool to:
Allow more questions to
be answered faster
Change decisions
Improve outcomes
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Clinical Decision Support Changes Clinical Decisions
Phua J, See KC, Khalizah HJ, et al. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds.
Singapore Med J 2012; 53:116.
37%
Researchers at Singapore’s National University
Hospital report that bedside use of UpToDate led to
changes in patient care decisions 37% of the time
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Researchers at Harvard University Find: UpToDate Associated with Improved Outcomes
Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals.
J Hosp Med 2012; 7:85.
Use of UpToDate Associated with...
Improved Quality Every condition on Hospital Quality Alliance Metrics
Shorter Lengths of Stay 372 000 days over 1 year
Lower Mortality Rates 11 500 lives over 3 years
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Impact: Changing Millions of Clinical Decisions
-
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
Topic Hits
A Quarter Billion (254 877 259) Topic Views in 2013
over 80 million changed Decisions
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Using UpToDate Increases Medical Knowledge
20 Minutes a day
McDonald, F, Zeger, SC, Kolars, JC. Factors Associated with Medical Knowledge
Acquisition During Internal Medicine Residency J Gen Intern Med 2007. 19
Equals an Entire
Year of Residency
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Future of CDS
Business Trends
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Unsustainable costs
Demographic trends/shortages of clinicians
Quality of care Emphasis shift from quantity to quality
Improved outcomes
Patient satisfaction
Reduced waiting times
Patient safety
Length of stay
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Global Healthcare Challenges
See “Future Challenges to the Provision of Healthcare in the 21st Century,” Dr Raymond Lang
Medical education Knowledge of the latest medical information
Providing effective patient information as
patients become more engaged
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Policies: Patient Safety in the EU 2014: What is the
Issue?
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What is the EU Response?
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Areas to Improve
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Areas to improve (Cont.)
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STRUCTURAL & INVESTMENT FUNDS (EIFS):
ERDF= European Regional Development Funds
ESF=European Social Funds
Cohesion Funds
CENTRAL FUNDS:
THIRD HEALTH FRAMEWORK PROGRAMME (€450M)
Objective 4: Access to better and safer healthcare through better a access to medical expertise and
information
HORIZON 2020 (€80B)
Predictive medicine Open Call : €104M
AGEING WELL WITH ICT INITIATIVE (€700M)***
Good News: FOCUS = €
**Previous framework
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Architectural view: One Roadmap for the Future
The European EMR Adoption Model in 7 Stages to Highest
Quality in Patient Care
“Paperless” patient record environment for highest quality of
care, data continuity & full HIE
Electronic diagnostic and pharmacy department
information
A patient-centered electronic data repository
Clinical ordering and documentation – especially nursing care
Electronic order entry with decision support and result
reporting
Completely electronic diagnostic image management
Full electronic clinical decision support, and highest
medication safety
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• Knowledge Base
• Current, comprehensive, evidence-based
• Summary & detailed presentations
• Expert recommendations
• Rich & dynamic content: graphics, video, calculators
• Advanced Search
• Intuitive, auto-complete
• Filters for content type (e.g., adult vs pediatric)
• Multi-lingual search and navigation*
• Context > Bidge Patient-Doctor Gap
• Personalised Medicine: Integrates EHR data re: patient
• Location: Available at the point of care.
Architecting Tomorrow’s Clinical Decision Support
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The Right Guidance
The Right Decision
At the Right Time
Context & Format Clinicians
Find Useful
*Search in Korean is currently in beta testing
Simplified &
Traditional Chinese;
Korean*, Japanese,
English, Portuguese,
Spanish, French,
German, Italian
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The Point of Care is … Anytime, Anywhere
30 UpToDate 2014 Survey of 930 practitioners in 68 countries.
Mobile Health Adoption is
here to stay:
77% Doctors use a smartphone
during practice
70% Doctors use mobile devices for
clinical decision support
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National Strategies: CDS is Key to Standardizing
Public Healthcare
UpToDate has national contracts
with the governments of Norway,
Spain , Saudi Arabia and Oman to
standardize public healthcare on
UpToDate
In countries such as the
Netherlands, Belgium,
Switzerland and Luxembourg,
UpToDate is used country-wide
STANDARDIZATION OF CARE = HEALTHCARE DEMOCRACY
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Scalable Solutions to Increase the Impact on Care:
From silos to integrated approaches
National Access
Hospital System/ Group /Region
Hospital
Care Team
Individual Doctor
I
M
P
A
C
T
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Future of CDS
Integration and Access: A new way to practice
medicine
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The Most Valuable HIT Initiative for Patient Care
Source: UpToDate individual subscriber survey 2012
Which IT initiative produces the greatest benefit
to the quality and safety of patient care?
26.53
31.35
32.68
33.41
36.28
37.39
54.31
20 30 40 50 60
Order sets
CPOE
Patient ed
Alerts/reminders
eRx
EHR system
UpToDate CDS
Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127)
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Increased Clinician Satisfaction with the EHR
Is important
to patient care
Enhances
satisfaction with their EHR
Encourages
utilization of their EHR
Source: June 2011 Clinicians Survey N=1228
Users said that having UpToDate embedded in their EHR
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Realize Benefits of Embedding UpToDate in the EHR:
CDS in the Workflow
Increase utilization of EHR and
UpToDate
Personalized searched based on the patient’s profile
Easy access in the clinical
Workflow
(“one-shop”)
Increase clinician satisfaction
Benefits
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Standard search
UpToDate accessed via search box, button/icon or link
Very limited contextual support (e.g., adult/pediatric/patient)
HL7 Infobutton or HL7-assisted free text search
More contextual information is sent for an HL7 targeted search
than for a standard targeted search
UpToDate accessed via a button/icon or search box
Access Options:
Standard Search versus HL7 Infobutton
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Leveraging HL7 Infobuttons
Context Aware Knowledge Retrieval Applications
“Lower barriers to the access of knowledge
resources at the point of need” (HL7)
Tailored searches of CDS content contextual to your
specific patient
Search CDS targeted to your patient:
• Disease
• Condition
• Medication
• Lab results
• Age
• Gender
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Are You Future-Ready?
CDS considerations for your eHealth Strategy
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An Achievable Vision: CDS everywhere
Imagine:
• CDS resources accessible in
the workflow of all your
country’s major clinical
systems within 3 years.
• Improved access to CDS
ensuring improved quality of
care
• Estonia at the vanguard of
medicine
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• Treat mobile as “the” next platform
• Not a “nice-to-have”, but a “must-have”
• Develop next-gen experience with mobile in mind:
• Globally scaled: Multi-language search and navigation
• Mobile-Responsive display/formatting
• Adaptable for smartphones vs tablets
• App support for iOs, Android, Windows 8
• Ease of use tools for mobile: Bookmarks, history, etc.
• Access support for both individuals and enterprises.
Evolving Clinical Decision Support for Mobile
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CDS: Impact for Estonia
Healthcare Standardization => Health democracy (Geo/Function)
Egalitarian InfOstructure = > Unlimited usage 24/7 > Anywhere,
Anytime, as much as needed and on-demand.
Easy to integrate into your eHealth strategy/EHR => Quick Win.
Demonstrated ROI => Scalable and Sustainable Healthcare System.
Advancement of medical education => Capacity Building /e-Learning)
Key Building Block of eHealth Strategy (possible from Phase I) and one of
the best solutions at the point of care.
IMPROVED HOSPITAL PERFORMANCE AND PATIENT CARE
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Evaluate CDS in a partnership between HIT and clinical leaders
Ensure that CDS is an integral part of your EHR plan from the
outset
mHealth is here to stay – include CDS in your eHealth strategy
Getting it Right: Anticipate Tomorrow’s CDS Today
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Aitäh!
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