Evolution of the Knowledge Management Program at Partners HealthCare - PowerPoint PPT Presentation

Evolution of the Knowledge Management Program at Partners HealthCare (PHS) Roberto A. Rocha, MD, PhD, FACMI Clinical Informa9cs Director, Partners e Care, Partners Healthcare System Assistant Professor of Medicine Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School Learning Health System (LHS) Seminar - October 7, 2016 -

Overview • History – Goals, types of assets, ini9al challenges, tac9cs • Current state – Program, principles, types of assets – New challenges, revised tac9cs • Implementa9on framework – Levels of support, areas of focus • Future direc9ons • Conclusions

HISTORY

Knowledge Management • Established in 2003 as a formal func9on within the Clinical Informa9cs R&D group – clinical team within Informa9on Systems • Responsibility for designing, developing, and suppor9ng processes , tools , and assets – e.g. governance, lifecycle, authoring, deployment • Enterprise content areas – e.g. terminologies, catalogues, rules, reference sources, etc.

Original Strategic Goals • Reduce the cost and increase the speed of knowledge acquisi9on and maintenance for decision support • Speed transla2on of clinical innova9on and evidence into clinical prac9ce • Proac2ve , an2cipatory decision support architecture to set founda9on for personalized medicine – avoid “interrup9ve” decision support • Improve Partners’ organiza2onal effec2veness as a learning organiza9on through organiza9onal alignment and data-driven performance improvement • Align knowledge assets with business, regulatory, safety and quality requirements • Only build what we cannot buy • Partners has created some of the best decision support in produc9on in the world, the goal here is to keep the knowledge up to date Slide created by Tonya Hongsermeier, MD, MBA (Mar 2006)

Content Examples at PHS • Medica2on Data Dic9onary with default doses, weight-based doses, dose strings, and drug-drug interac9on checking – mul9ple applica9ons and popula9ons via Common Medica9on Services • Gerios and Nephros for proac9ve dosing for elderly and/or renal insufficient • Drug-lab monitoring, duplicate drug checking, drug-group checking, drug-disease checking, drug-pregnancy checking • Primary and secondary preven9ve health reminders • Results Manager ( abnormal test results ) • Inpa9ent and outpa9ent order sets • Inpa9ent interac2ve rules (applica9on specific, hard-coded) • Concept dic2onary and problem list • Pa9ent monographs • Radiology ordering decision support • Outpa9ent documenta2on templates Slide created by Tonya Hongsermeier, MD, MBA (Mar 2006)

Content Life-Cycle Challenges Slide created by Tonya Hongsermeier, MD, MBA (Mar 2006)

Clinical Content Committee Slide created by Tonya Hongsermeier, MD, MBA (Mar 2006)

Deployed Tactics (2008) • Transparency and Governance (2004) – Document library portal of decision support knowledge specifica9ons in produc9on § 600 documents represen9ng 10s of 1000s of rules – New governance and subject ma`er expert panels • Collabora2on and Content Life-cycle Tools (2005) – Collabora9on Portals aligned with governance and business goals of Partners § 60 spaces to date, Documentum’s eRoom – Content Management infrastructure for sharing, versioning, audi9ng, scheduling, tracking § Documentum’s Content Management Services • Content Edi2ng Re-architecture (2006) – Once decision is made for knowledge to change, change will be implemented rapidly at all touch-points – Primary focus of KM development going forward Slide created by Tonya Hongsermeier, MD, MBA (2008)

Medication Dictionary: KM Workflow Choose ENTERPRISE Ingredients) Yes Select or free Select or free Select or free List text Dose No text Strength(s) text Indication(s) Ingredient(s)? Form(s) (if Yes (if applicable) (if applicable) applicable) ID Drug / Compound Preview Commercially Choose Create Assign other Get Research Med Select Type Select Route GCNSEQNO Assign/create Assign/create Available Ingredient/ Generic defining No Request (if applicable) of Entry Grouping return list( Internal Name External Name (default) Ingredient Set Name characteristics? (optional) Commercially Available Drug Incorporate Yes into DDI KB Similar to pre- Assess Yes existing DDIs Enter concept? Enter Yes Yes Labs data Comments Flag for DDI No review Select none, 1, or KM Assign Accept or Accept or View list of DDIs Labs data Select more; or create No systemic absorption No Comments No Allowable override override Brand names applicable? applicable? Population new Synonym(s) needed? Route(s) Frequency list Dose+Unit(s) list ID Drug / Compound ID Drug with Select Max Select Rounding Select Max Select Max Yes Ingredient(s)? Dose (Daily) Dose (Weeky) Dose (Lifetime) Increment units calculation calculation calculation Enter Enter Enter Enter Yes Yes Yes Yes Enter text text text text Use as Enter Max Enter Max Enter Max “Empty” list of Create new Compond with Yes Yes Rounding chemo? Dose (Daily) Dose (Weekly) Dose (Lifetime) Brand names Synonym(s) Ingredient(s)? Increment Dispensing Prescribing Administration Patient Chemo Other No Advice No Advice No Advice No Advice No ID Drug drug? Population(s)? needed? needed? needed? needed? without Ingredient(s)? No No Similar to pre- Similar to pre- Flag for Similar to pre- Flag for Linked to Flag for existing concept existing concept Nephros existing concept Gerios “external” FDI review or FDB has data? or FDB has data? review or FDB has data? review editors Assess Assess Assess Yes Nephros Yes Gerios FDIs Yes data data Input site- Review SAVE as specific Summary/ Enterprise data FDIs Nephros Gerios Preview No Version No applicable? applicable? applicable? screen

KM software tools 10-15 loosely connected tools used just to maintain Meds

CURRENT STATE

CKM Program • Systema2c and sustainable acquisi9on, adapta9on (localiza9on), and management of knowledge assets for different “modali9es” of CDS • Includes the adapta2on of “reference” knowledge to reflect local and ins9tu9onal requirements, resources, and priori9es • Follows a well-defined lifecycle , including specific stages for documenta9on, tes9ng, and monitoring – supported by integrated set of tools and resources Rocha RA, Maviglia SM, Sordo M, Rocha BH. Clinical knowledge management program. In: Greenes RA, editor. Clinical Decision Support - The Road to Broad Adop9on (Second Edi9on). Burlington: Academic Press; 2014. p. 773-817

Program guiding principles @ PHS • Objec9vely improves safety , quality , and efficiency • Supported by evidence , clinical best prac2ces , and sound clinical thinking • Aligns with and promotes clinical and business goals • Acceptable to prac9cing end users (workflow integra9on) • Adheres to informa9cs and knowledge management best prac2ces • Best u9lizes talent , resources , and capital of Partners • Supports research and teaching missions of Partners

Inventory of Knowledge Assets Managed Centrally at Partners (1/2) Rocha RA, Maviglia SM, Sordo M, Rocha BH. Clinical knowledge management program. In: Greenes RA, editor. Clinical Decision Support - The Road to Broad Adop9on (Second Edi9on). Burlington: Academic Press; 2014. p. 773-817

Inventory of Knowledge Assets Managed Centrally at Partners (2/2) Rocha RA, Maviglia SM, Sordo M, Rocha BH. Clinical knowledge management program. In: Greenes RA, editor. Clinical Decision Support - The Road to Broad Adop9on (Second Edi9on). Burlington: Academic Press; 2014. p. 773-817

CKM Lifecycle @ PHS Request (new or update) Authorize & Evaluate Priori9ze Monitor Design Test & Deploy Implement

Ongoing activities @ PHS • Transi2on! – Partners eCare : implementa9on of Epic § System is live at BWH, MGH, NWH, MEEI, and PCPO – Migra9on (and preserva9on) of legacy assets – Evolving understanding of what Epic can/cannot do • Implemen9ng analy9cs plakorm for Clinical KM – Monitoring and evalua9on of CDS interven9ons – Op9miza9on of KM ac9vi9es • Completed new KM solware plakorm ( CKMS ) – Repository + Portal + Authoring + SME Collabora9on – System live since February 2015

Partners e Care

Program milestones @ PHS ü Establish governance structure with clear guiding principles ü Define priori2es considering ongoing programs & ini9a9ves ü Catalog features & content available in legacy systems ü Assimilate features & content available in new EHR system ü Resolve or mi9gate iden9fied gaps (features & content) ü Define work plan aligned with EHR implementa9on 9meline ü Implement KM lifecycle (available tools) ü Implement monitoring process (CDS interven9ons) o Replace isolated tools with integrated infrastructure o Expose assets and processes to users and stakeholders o Expand monitoring process (KM lifecycle & CDS evalua2on ) o Engage and collaborate with other organiza9ons

CDS Monitoring Portal

CDS Monitoring: Example Released silent (Sep) Revision (Nov) Released ac2ve (Dec) Reminder to document a principal problem 09/15/15 - Released silent for monitoring; firing was excessive 11/17/15 - Revised to fire only on admi`ed pa9ents (exclude ED pa9ents) 12/22/15 - Ac9vated; ~200 pa9ent-alerts/day