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BCATPR 2013 | RenalConnect & Read by QxMD
- 1. Knowledge Translation & Care Pathway Optimization Using Mobile and Web Based Tools Daniel Schwartz, MD June 18, 2013
- 2. Objectives Learn about the impact of a web-based patient management tool that helps health care professionals adhere to best practices while collecting useful administrative & CQI data Become familiar with the impact of mobile apps for smartphones and tablets that can be utilized to access decision support tools and personalized reference materials at the point of care
- 3. 1 in 10 patients is actually harmed while receiving hospital care
- 4. What is wrong with me?
- 5. What will happen to me?
- 6. What is the best treatment for me?
- 8. Taking Breathing For Granted…
- 9. Taking Breathing For Granted…
- 11. Savings Lives by Moving a Dial High lung volumes | Mortality 40% Low lung volumes | Mortality 31%
- 13. Medical literature is constantly being published Landmark clinical research, if adopted and put into practice by healthcare practitioners, has the capacity to save lives Medical Literature as a Source of Knowledge
- 14. HCPs may not stay up-to-date with landmark clinical research It often takes years for the latest best-practices to be integrated into a physician‟s practice The Problem
- 15. Barrier to Discovery 1,000s of Medical Journals; each journal publishes hundreds or thousands of papers/year Difficult to separate the wheat from the chaff Barrier to Access Content hidden behind paywalls University and hospital site licenses still require extensive effort to navigate Why?
- 16. Think PubMed meets Flipboard Solution: „Read by QxMD‟
- 17. Personalized Medical Journal Use combination of crowdsourcing, data feeds, aggregated behaviour analysis to display content important to the user Navigate institutional access and site-licenses seamlessly http://qx.md/read Read by QxMD
- 18. Traditional Access Method Using ‘Read by QxMD’ • Search for paper of interest • Click to view • Paper behind paywall? • Navigate to institution for institutional access • Login • Search for paper • Find and select paper in search results • Estimated Time: ~ 5 min • Discover paper of interest • Tap to view • Heal the sick • Estimated Time: < 20 seconds Comparison Accessing a Paper
- 20. Save >100K lives per year just by doing what we already know we‟re supposed to do1 Impact 1To Err Is Human: Building a Safer Health System. Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press; 1999. ISBN: 9780309068376.
- 21. Read
- 22. Demo
- 23. Evidence Necessary but not sufficient
- 24. Knowledge Translation Current Practice Improved Patient Outcomes Evidence
- 26. Prognosis | What will happen to me? Kidney Failure Risk Equation
- 27. Therapeutics | Best treatment?
- 29. Simple Tools Make Big Differences “Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines.” Durieux et al. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med. 2009 Nov 17;151(10):677-86. Full text: http://qxmd.com/r/19920268
- 30. Checklists A simple safety checklist (the Surgical Safety Checklist) in the operating room can significantly reduce post- operative complications. Specifically, death after surgery was reduced by more than 40%.
- 33. Kids Are Not Small Adults
- 35. Impact of Clinical Decision Support Decision support systems can improve clinical practice But, up to 30% of systems don‟t have any meaningful impact Kawamoto et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 http://qxmd.com/r/15767266
- 36. Web Apps in Renal Care
- 37. Peritonitis Intra-abdominal infection Achille‟s heel of home dialysis
- 39. Peritonitis Peritonitis Tracking & Management Solution Tracking = Data Management = Clinical Decision Support
- 40. Technical aspects Web-based application hosted in the cloud (“cloud computing”) Written in Perl, HTML, JavaScript, and CSS >10,000 lines of code MySQL database for data storage Open source – on Github github.com/renalconnect/RenalConnect
- 41. Protocolized care Patient presents with peritonitis Start antibiotics empirically, send PD fluid swabs for culture & sensitivity Follow-up culture results, then modify treatment Repeat culture at end of antimicrobial treatment to confirm clearance Organize home visit, patient education to increase chance of peritonitis-free PD Continue ongoing regular follow-up
- 45. Alerts
- 46. BEFORE
- 47. AFTER
- 48. Accomplishments | Peritonitis Rate 2008 1:20 months 2009 1 :21.5 months 2010 1:26.6 months 2011 1:30.6 months 2012 1:34 months
- 51. What‟s coming?
- 53. Going to Medical School
- 57. Google Glass
- 58. Heads Up Display
- 60. Google Glass in Healthcare Anatomical landmarking during procedures Assistance with access canulation Listen in to the conversation Semantic analysis of speech Auto-suggest differential diagnosis, phone numbers, drug dosing View patient results at the point of care
- 61. Rounding in the HD unit Past medical history Acute issues to follow up (eg investigations, referrals, BP/goal weight, etc) Pending appointments Chronic issues Transplant status (referred? If no, why?) Access (line? If so, why?) Code status (what is it? Documenting „Full Code‟?) Plans for home dialysis? “Right Start” action items
- 62. Better outcomes from the application of better evidence Point of Care Delivery
- 63. Acknowledgements Mobile Apps (Calculate, Read) Chan Kruse Michael Verde Stephane Boyer Dimas Yusuf PTMS (Renal Connect) Dimas Yusuf
Editor's Notes
- The rise of smartphones, tablets and web apps have provided opportunities to enhance evidence-based practice. RenalConnect ensures adherence to care pathways for patients with end stage renal disease, while providing robust, real-time analytics that can be used to evaluate CQI activities. Mobile apps such as Calculate by QxMD (qx.md/calculate) and Read: Personalized Medical Journal (qx.md/read) encourage engagement with & application of current research and best practices. These applications will be discussed as a means to facilitate knowledge translation at the point of care.
- To Err is Human Report 98,000 deaths/year
- Membranous Nephropathy Prognosis
- http://173.83.147.235/dimas.yusuf@gmail.com111111