The Next Generation of Clinical Decision Support (CDS) Pilar Hermida, Director UpToDate

Transcription

1 The Next Generation of Clinical Decision Support (CDS) Pilar Hermida, Director UpToDate 15 th January 2015

2 Objectives 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

3 First, a Story: The Night mhealth Saved a Life 2

4 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? UpToDate.! 3

5 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. a life I was able to save thanks to immediate access to UpToDate on my cell phone. 4

6 Doctors Have Clinical Questions 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 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. 5

7 Clinical Decision Support (CDS) Definitions 6

8 What is UpToDate? 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 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 7

9 A New Way to Practice Medicine What s New/ Practice Changing Updates Clinical topics Drug entries Patient topics CME/CPD Graphics 140+ Medical calculators Evidence links Physician authors 22 Specialties CHANGE IN MEDICAL PRACTICE 8

10 Option 1: UpToDate Search Box Best Practice! 9

11 Option 2: UpToDate Link 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) Toolbar: Menu/List: 10

12 Option 3: UpToDate Targeted Search 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 11

13 21+ years For 21+ years, the most trusted evidence based, peer reviewed editorial content, proven to improve patient care quality A Trusted Resource authors Expert evidence-based recommendations made by over physician authors from 51 countries searches Clinicians view more than 250 million topics annually in UpToDate, changing 80 million clinical decisions clinicians Over clinicians and 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 12

14 Find Answers Faster Search in Patent translation technology with: 9 languages Auto complete Navigation Customized default language Translation feedback 13

15 Clinical Decision Support (CDS) Impact 14

16 Research Demonstrates UpToDate Impacts Outcomes 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 We invite you to review the study data yourself: 15

17 Clinical Decision Support Changes Clinical Decisions 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 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:

18 Researchers at Harvard University Find: UpToDate Associated with Improved Outcomes Use of UpToDate Associated with... Improved Quality Every condition on Hospital Quality Alliance Metrics Shorter Lengths of Stay days over 1 year Lower Mortality Rates lives over 3 years Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85. 17

19 Impact: Changing Millions of Clinical Decisions A Quarter Billion ( ) Topic Views in ,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 - Topic Hits over 80 million changed Decisions

20 Using UpToDate Increases Medical Knowledge 20 Minutes a day Equals an Entire Year of Residency McDonald, F, Zeger, SC, Kolars, JC. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency J Gen Intern Med

21 Future of CDS Business Trends 20

22 Global Healthcare Challenges Quality of care Emphasis shift from quantity to quality Improved outcomes Patient satisfaction Reduced waiting times Patient safety Length of stay Medical education Knowledge of the latest medical information Providing effective patient information as patients become more engaged Unsustainable costs Demographic trends/shortages of clinicians See Future Challenges to the Provision of Healthcare in the 21st Century, Dr Raymond Lang 21

23 Policies: Patient Safety in the EU 2014: What is the Issue? 22

24 What is the EU Response? 23

25 Areas to Improve 25

26 Areas to improve (Cont.) 26

27 Good News: FOCUS = 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)*** **Previous framework

28 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 Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information

29 Architecting Tomorrow s Clinical Decision Support Knowledge Base Current, comprehensive, evidence-based Summary & detailed presentations Expert recommendations Rich & dynamic content: graphics, video, calculators Context & Format Clinicians Find Useful At the Right Time The Right Guidance The Right Decision 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. Simplified & Traditional Chinese; Korean*, Japanese, English, Portuguese, Spanish, French, German, Italian *Search in Korean is currently in beta testing 29

30 The Point of Care is Anytime, Anywhere Mobile Health Adoption is here to stay: 77% Doctors use a smartphone during practice 70% Doctors use mobile devices for clinical decision support UpToDate 2014 Survey of 930 practitioners in 68 countries. 30

31 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 31

32 Scalable Solutions to Increase the Impact on Care: From silos to integrated approaches National Access I M P A C T Hospital System/ Group /Region Hospital Care Team Individual Doctor 32

33 Future of CDS Integration and Access: A new way to practice medicine 33

34 The Most Valuable HIT Initiative for Patient Care Which IT initiative produces the greatest benefit to the quality and safety of patient care? UpToDate CDS EHR system erx Alerts/reminders Patient ed CPOE Order sets Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127) Source: UpToDate individual subscriber survey

35 Increased Clinician Satisfaction with the EHR Users said that having UpToDate embedded in their EHR Is important to patient care Enhances satisfaction with their EHR Encourages utilization of their EHR Source: June 2011 Clinicians Survey N=

36 Realize Benefits of Embedding UpToDate in the EHR: CDS in the Workflow Easy access in the clinical Workflow ( one-shop ) Benefits Increase utilization of EHR and UpToDate Increase clinician satisfaction Personalized searched based on the patient s profile 36

37 Access Options: Standard Search versus HL7 Infobutton 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 37

38 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 38

39 Are You Future-Ready? CDS considerations for your ehealth Strategy 39

40 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

41 Evolving Clinical Decision Support for Mobile 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. 41

42 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 42

43 Getting it Right: Anticipate Tomorrow s CDS Today 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 43

44 Aitäh! 44