Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century

EMPOWERING CLINICAL LEADERS

Dr Lalit Singh, M.S., FIAGES, MBADirector Content and Product StrategyElsevier Health Solutions

Life of a physician in 2016 From an era of lack of information to that of information overload!

Why talk about Clinical Decision Support ?

Provided all the correct inputs in a complex scenario, a machine is likely to make better decisions than an individual

We are all trying toINCREASE THE VALUE ofour health & healthcare…

Value = Quality/Cost

So, what are we trying to achieve?

Improve Patient Outcomes

Control the Costs of Care

Maximize Patient Throughput

What Stands in the Way?

VARIABILITY

Variable Cost, Quality, Efficiency Uniform Cost, Quality, Efficiency

VARIABILITY IN HEALTH & HEALTHCARE DELIVERY DRIVES DOWN QUALITY, DRIVES

UP COSTS,AND REDUCES PATIENT THROUGHPUT

The Damage Caused by Variability in the Delivery of Healthcare…

400,000 PREVENTABLE DEATHS ANNUALLY

10,000 PREVENTABLE SERIOUS COMPLICATIONS

DAILY

12,000,000 AMBULATORY DIAGNOSTIC ERRORS, 50% POTENTIALLY SERIOUS

Data from The US

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In the high risk airline industry, reduced variability is the cornerstone of customer safety.

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Henry Ford

His creation in 1913 of the assembly line revolutionized the manufacturing across the globe, dramaticallyincreasing productivityand reducing costs…

Reduced variability was a critical feature of Ford’s high efficiency assembly line.

So how do we UNIFORMLY & SUSTAINABLY

REDUCE VARIABILITY IN HEALTHCARE DELIVERY

to decrease the cost and increase

the quality and productivity of our healthcare system?

CLINICAL

DECISION

SUPPORT

Solutions which empower providers & patients with current, credible, evidence-based and evidence-informed guidance

C

D

S

An Electronic Medical Record

IS NOT

in-and-of itself a

Clinical Decision Support solution!

An EMR is an efficient, consistent

way to deliver CDS solutions

to physicians, nurses, pharmacists, other traditional

care providers, and to patients.

The key to better adoption of HIS among physicians is to give them a compelling reason to do so!

How do we ensure our clinicians adopt Clinical Decision Support?

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Different types of Clinical Decision Support (CDS)

• Information support delivers passive content which the user has to interpret

• Action rules commonly used to deliver alerts and reminders

• Computer-Interpretable Guidelines (CIGs) provide active decision support that:

Customises content to each patient

Uses data from electronic medical record when this is available

Is associated with improved outcomes

Actively interprets guidelines in the light of patient data & prompts if more data is needed

Simplifies content by automatically customising the guidelines appropriate for each patient journey over time

Presents personalised reasons for options, with arguments for & against

Records decisions selected & tasks performed, along with variance tracking

HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,

GOALCLINICAL DECISION SUPPORT STRATEGY

FOUNDATION

HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,

Current, Credible, Evidence-based ContentMinimally Disruptive to Provider Workflow

Rapidly Delivered to All Points of Patient CareHelps Record and Analyze Clinical Data for Providers and Policy Makers

HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,

Current, Credible, Evidence-based ContentMinimally Disruptive to Provider Workflow

Rapidly Delivered to All Points of Patient CareHelps Record and Analyze Clinical Data for Providers and Policy Makers

PHYS

ICIA

NS

NU

RSE

S

Oth

er C

are

Prov

ider

s

PATI

ENTS

PILLARS

Pull

Push

SOLUTIONS

“Pull” CDS solutions allow care providers to seek out and consider current, credible, evidence-based information and guidance…

“Push” CDS solutions force care providers to consider current, credible, evidence-based information and guidance…

The combination of “Push” and “Pull” CDS solutions

most empowers all 4 providers

HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,

Current, Credible, Evidence-based ContentServes All Major Care Provider Types

Rapidly Delivered to All Points of Patient CareMinimally Disruptive to Provider Workflow

PHYS

ICIA

NS

NU

RSE

S

Oth

er C

are

Prov

ider

s

PATI

ENTS

SOLUTIONS

HIGH QUALITY, COST EFFICIENT HEALTHCARECONSISTENT, SUSTAINABLE,

Current, Credible, Evidence-based ContentServes All Major Care Provider Types

Rapidly Delivered to All Points of Patient CareMinimally Disruptive to Provider Workflow

PHYS

ICIA

NS

NU

RSE

S

Oth

er C

are

Prov

ider

s

PATI

ENTS

ORDERSETS(push)

REFEREN

CE(pull)

CAREPATHWAYS(push & pull)

CAREPLANNING(push & pull)

REFEREN

CE(pull)

eLEARNIN

GSKILLS

LMS(push & pull)

CAREPLANNING(push & pull)

REFEREN

CE(pull)

eLEARNIN

GSKILLS

LMS(push & pull)

CAREPATHWAYS(push & pull)

ENGAGEMENT&

EDUCATION(push & pull)

COMPLETE STRATEGY

ELSEVIER

Over 25% ofthe World’s

Clinical Content Serving over 20M healthcare

professionals

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Elsevier’s Mission: Moving Knowledge into Practice

The intersection of trusted content and workflow-friendly solutions

• Over 100 years of trusted content • Deep expertise across all forms of

clinical content

• Solutions centered around clinical workflows

• Partnerships to ensure integration of content with technology

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ELSEVIER

Order Sets

Radiology& Pathology Reference Solutions

Physician Reference Solutions

Nursing Reference Solutions (Generalist and Specialist)

Clinical Skills for Nurses

Patient Engagement

Clinical Pathways

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Elsevier suite of applications supported by the World’s Best Content

Patient Focused

Radiology & pathology reference and CDS solutions

Easy to work with, user friendly ambulatory order sets

Personalised care pathways Impactful “low value” and “risk” alerts

Physician & pharmacist reference and CDS solutions

Customizable, multi-language & literacy level patient education solutions

The most powerful patient data collection solution

Nursing Skills, eLearning, learning management systems, reference & Care Plan Solutions

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Physician reference

Care PlansDrug information

Pharma reference

Nursing referenceNursing education

Patient engagement

Order sets

You

Non-integrated, non-communicative individual products fail to communicate or integrate and often provide conflicting guidance!

• More Costly• Too Many Contacts• More IT Challenges

WHY “BEST IN CLASS” PRODUCTS CAN’T DRIVE VALUE…

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• Less Costly• Fewer Contacts• Simpler IT

Physician reference

Care Plans

Drug information

Pharma reference

Nursing referenceNursing education

Patient engagement

Order sets ITERATIVE solutions that COMMUNICATE, INTEGRATE, and provide CONSISTENT guidance!

“BEST IN SUITE” SOLUTIONS DRIVE VALUE.

The problem has been with integration of our best in breed applications

Dr Mammen, CMC Vellore

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Building blocks of Arezzo guidelines

•Arezzo computer-interpretable guidelines (CIGs) are made up of• Tasks and collections of tasks• Data Items•Tasks and data items have attributes• Define the behaviour of the guideline during enactment by Arezzo Performer

•Arezzo has four basic types of tasks• Enquiries; Decisions; Actions; Plans• CIGs are made up of collections of these four basic types• Keystone is the parent type, which is used to link CIGs together

•

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Thank You!