The Next Generation of Clinical Decision Support (CDS) Pilar - - PowerPoint PPT Presentation

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The Next Generation of Clinical Decision Support (CDS) Pilar - - PowerPoint PPT Presentation

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The Next Generation of Clinical Decision Support (CDS) Pilar Hermida, Director UpToDate pilar.hermida@wolterskluwer.com 15 th January 2015 Objectives PART I: What is CDS? Clinical Decision Support (CDS): Definitions Clinical

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The Next Generation of Clinical Decision Support (CDS)

Pilar Hermida, Director UpToDate pilar.hermida@wolterskluwer.com 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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UpT pToDate te.! .!

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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%

  • f 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

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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

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Best st 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

  • ver 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:

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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

  • ver 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.

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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

29 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

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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

  • f 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

  • f 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

  • utset

 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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