BCATPR 2013 | RenalConnect & Read by QxMD

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Knowledge Translation and Care Pathway Optimization Using Mobile and Web-based Tools

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 and Read: Personalized Medical Journal 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.

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  • 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
  • BCATPR 2013 | RenalConnect & Read by QxMD

    1. 1. Knowledge Translation & CarePathway Optimization UsingMobile and Web Based ToolsDaniel Schwartz, MDJune 18, 2013
    2. 2. Objectives Learn about the impact of a web-based patientmanagement tool that helps health care professionalsadhere to best practices while collecting usefuladministrative & CQI data Become familiar with the impact of mobile apps forsmartphones and tablets that can be utilized to accessdecision support tools and personalized referencematerials at the point of care
    3. 3. 1 in 10 patients is actuallyharmed while receiving hospitalcare
    4. 4. What is wrong with me?
    5. 5. What will happen to me?
    6. 6. What is the best treatment for me?
    7. 7. Providing Better AnswersDiagnosisPrognosisTherapeutics
    8. 8. Taking Breathing For Granted…
    9. 9. Taking Breathing For Granted…
    10. 10. Full text: http://qxmd.com/r/10793162
    11. 11. Savings Lives by Moving a Dial High lung volumes | Mortality 40% Low lung volumes | Mortality 31%
    12. 12. http://qxmd.com/r/16304249
    13. 13.  Medical literature is constantly being published Landmark clinical research, if adopted and put intopractice by healthcare practitioners, has the capacity tosave livesMedical Literature as aSource of Knowledge
    14. 14.  HCPs may not stay up-to-date with landmark clinicalresearch It often takes years for the latest best-practices to beintegrated into a physician‟s practiceThe Problem
    15. 15.  Barrier to Discovery 1,000s of Medical Journals; each journal publishes hundredsor 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 extensiveeffort to navigateWhy?
    16. 16. Think PubMed meets FlipboardSolution:„Read by QxMD‟
    17. 17.  Personalized Medical Journal Use combination of crowdsourcing, data feeds, aggregatedbehaviour analysis to display content important to the user Navigate institutional access and site-licenses seamlesslyhttp://qx.md/readRead by QxMD
    18. 18. Traditional Access Method Using ‘Read by QxMD’• Search for paper of interest• Click to view• Paper behind paywall?• Navigate to institution forinstitutional access• Login• Search for paper• Find and select paper insearch results• Estimated Time: ~ 5 min• Discover paper of interest• Tap to view• Heal the sick• Estimated Time: < 20 secondsComparisonAccessing a Paper
    19. 19. Save >100K lives per year just bydoing what we already know we‟resupposed to do1Impact1To 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 ofMedicine. National Academies Press; 1999. ISBN: 9780309068376.
    20. 20. Read
    21. 21. Demo
    22. 22. EvidenceNecessary but not sufficient
    23. 23. Knowledge TranslationCurrent PracticeImproved PatientOutcomesEvidence
    24. 24. Full text: http://qxmd.com/r/21482743
    25. 25. Prognosis | What will happen to me?Kidney Failure Risk Equation
    26. 26. Therapeutics | Best treatment?
    27. 27. MembranousNephropathyWatchful waitingOrMedical therapy
    28. 28. Simple Tools Make Big Differences“Testing for pulmonary embolismoften differs from that recommendedby evidence-based guidelines.”Durieux et al. A computerized handheld decision-support systemto improve pulmonary embolism diagnosis: a randomized trial. AnnIntern Med. 2009 Nov 17;151(10):677-86.Full text: http://qxmd.com/r/19920268
    29. 29. Checklists A simple safety checklist (the Surgical Safety Checklist) inthe operating room can significantly reduce post-operative complications. Specifically, death after surgery was reduced by morethan 40%.
    30. 30. Kids Are Not Small Adults
    31. 31. Impact of Clinical Decision Support Decision support systems can improve clinical practice But, up to 30% of systems don‟t have any meaningfulimpactKawamoto et al. Improving clinical practice using clinical decision supportsystems: a systematic review of trials to identify features critical to success.BMJ 2005; 330http://qxmd.com/r/15767266
    32. 32. Web Apps in Renal Care
    33. 33. Peritonitis Intra-abdominal infection Achille‟s heel of home dialysis
    34. 34. Peritonitis Peritonitis Tracking & Management Solution Tracking = Data Management = Clinical Decision Support
    35. 35. 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
    36. 36. Protocolized carePatient presentswith peritonitisStart antibioticsempirically, send PDfluid swabs forculture & sensitivityFollow-up cultureresults, then modifytreatmentRepeat culture at endofantimicrobialtreatment toconfirm clearanceOrganize home visit,patient education toincrease chance ofperitonitis-free PDContinue ongoingregular follow-up 
    37. 37. Accessing the service
    38. 38. Alerts
    39. 39. BEFORE
    40. 40. AFTER
    41. 41. Accomplishments | Peritonitis Rate20081:20months2009 1:21.5months20101:26.6months20111:30.6months20121:34months
    42. 42. What‟s coming?
    43. 43. Going to Medical School
    44. 44. AirstripTechnologies
    45. 45. Google Glass
    46. 46. Heads Up Display
    47. 47. Demo Videohttp://youtu.be/9c6W4CCU9M4
    48. 48. 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, drugdosing View patient results at the point of care
    49. 49. Rounding in the HD unit Past medical history Acute issues to follow up (eg investigations, referrals, BP/goalweight, 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
    50. 50. Better outcomes from theapplication of better evidencePoint of Care Delivery
    51. 51. AcknowledgementsMobile Apps (Calculate, Read) Chan Kruse Michael Verde Stephane Boyer Dimas YusufPTMS (Renal Connect) Dimas Yusuf

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