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

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 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

First, a Story: The Night mHealth Saved a Life 2

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? UpT pToDate te.! .! 3

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

Doctors Have Clinical Questions Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical Answering all clinical encounters generate a question questions could change 5 to 8 Physicians have approximately 11 clinical questions a day 60 % patient management decisions each day of questions go unanswered Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218; 5 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.

Clinical Decision Support (CDS) Definitions 6

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 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 7

A New Way to Practice Medicine What’s New/ Practice Changing CME/CPD Updates 10 000+ 28 000+ Clinical topics Graphics 5 100+ 140+ Drug entries Medical calculators 1500+ 380 000+ Patient topics Evidence links 22 5 700+ Specialties Physician authors CHANGE IN MEDICAL PRACTICE 8

Best st Practice ! Option 1: UpToDate Search Box 9

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

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

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 250 000 000+ searches Clinicians view more than 250 million topics annually in UpToDate, changing 80 million clinical decisions 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 12

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

Clinical Decision Support (CDS) Impact 14

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 15 We invite you to review the study data yourself: http://www.uptodate.com/home/research

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. 16 Singapore Med J 2012; 53:116.

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  372 000 days over 1 year Lower Mortality Rates  11 500 lives over 3 years Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. 17 J Hosp Med 2012; 7:85.

Impact: Changing Millions of Clinical Decisions A Quarter Billion (254 877 259) Topic Views in 2013 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 - Topic Hits over 80 million changed Decisions

Using UpToDate Increases Medical Knowledge Equals an Entire 20 Minutes a day Year of Residency McDonald, F, Zeger, SC, Kolars, JC. Factors Associated with Medical Knowledge 19 Acquisition During Internal Medicine Residency J Gen Intern Med 2007.

Future of C DS Business Trends 20

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 21 See “ Future Challenges to the Provision of Healthcare in the 21st Century ,” Dr Raymond Lang

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

What is the EU Response? 23

Areas to Improve 25

Areas to improve (Cont.) 26

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

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

Architecting Tomorrow’s Clinical Decision Support • Knowledge Base • Current, comprehensive, evidence-based Context The Right Summary & detailed presentations • & Format Guidance Clinicians Find Useful Expert recommendations • At the The Right • Rich & dynamic content: Right Decision Time graphics, video, calculators • Advanced Search • Intuitive, auto-complete Simplified & Traditional Chinese; Filters for content type (e.g., adult vs pediatric) • Korean*, Japanese, English, Portuguese, Multi-lingual search and navigation* • Spanish, French, • Context > Bidge Patient-Doctor Gap German, Italian Personalised Medicine: Integrates EHR data re: patient • • Location : Available at the point of care. *Search in Korean is currently in beta testing 29

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 30 UpToDate 2014 Survey of 930 practitioners in 68 countries.

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

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

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