Clinical Decision Support By Hari


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Clinical Decision Support - Explained

Clinical Decision Support By Hari

  1. 1. MISYS – SOLUTIONS FOR HEALTHCARE Clinical Decision Support [email_address] Sr.Business Analyst
  2. 2. At the end of the session you will know…… <ul><ul><li>Decision Support systems </li></ul></ul><ul><ul><ul><li> a) Why Clinical support ? </li></ul></ul></ul><ul><ul><ul><li>b) How is that provided ? </li></ul></ul></ul><ul><ul><li>Why Decision Support ? </li></ul></ul><ul><ul><li>a) Need - why clinicians need that ? </li></ul></ul><ul><ul><li>b) when are they used ? </li></ul></ul><ul><ul><li>c) How is that Built ? </li></ul></ul><ul><ul><li>d) Advantages of using this system </li></ul></ul><ul><ul><li>What if a Decision Support is not available ? </li></ul></ul><ul><ul><li>Some Best Known Decision Support Systems. </li></ul></ul>
  3. 3. Decision Support Systems <ul><li>Support </li></ul><ul><li>System Support </li></ul><ul><li>Decision Support </li></ul><ul><li>Clinical Decision Support </li></ul>experience, solutions, results
  4. 4. Definition(s) <ul><li>Clinical Decision Support Systems are &quot;active knowledge systems which use two or more items of patient data to generate case-specific advice. </li></ul><ul><li>Clinical Decision Support systems link </li></ul><ul><li>health observations with health knowledge </li></ul><ul><li>to influence health choices by clinicians for </li></ul><ul><li>improved health care </li></ul><ul><li>(CDSS) are interactive computer programs, which are designed to assist physicians and other health professionals with decision </li></ul><ul><li>making tasks. </li></ul>experience, solutions, results
  5. 5. Objective of a CDSS <ul><li>To assist clinicians at the point of care. </li></ul><ul><li>Clinicians would interact with a CDSS to help determine </li></ul><ul><li>diagnosis, analysis, etc. of patient data. </li></ul><ul><li>Previous theories of CDSS were to use the CDSS to literally make </li></ul><ul><li>decisions for the clinician. </li></ul><ul><li>The clinician would input the information and wait for the CDSS to </li></ul><ul><li>output the “right” choice and the clinician would simply act on that </li></ul><ul><li>output. </li></ul>experience, solutions, results
  6. 6. Complexity in Treating patients <ul><li>Common Symptoms </li></ul><ul><li>Vitals Resembling Closely </li></ul><ul><li>Previous Case History ( For the patient ) </li></ul><ul><li>Previous Experiences ( For the prescriber ) </li></ul><ul><li>Ethnicity ( Asian , African , Hispanic , ………………………………………….. ) </li></ul><ul><li>Gender </li></ul>experience, solutions, results
  7. 7. How treatment is done by your doctor ? experience, solutions, results
  8. 8. Interactions <ul><li>a) Drug to Drug b) Drug to Food c) Food to Food … etc., </li></ul>experience, solutions, results Drug Indication Possible Effects SOURCE : Compiled from references in the bibliography. Coumadin Anticoagulant (blood thinner) Vitamin K is a nutrient in the body that helps blood to clot. Vitamin K is present in foods such as green, leafy vegetables and fish. It will interfere with a blood thinner like coumadin. Dilantin Anticonvulsant (anti-seizure) Vitamin D and folic acid levels in the body are decreased by the taking of these types of drugs. Norvasc Antihypertensive (for high blood pressure) Consuming foods high in sodium (i.e., licorice, processed meats, canned foods) will decrease the effectiveness of the drug. Aspirin Anti-inflammatory/pain reliever Taking large amounts of these drugs will cause a loss of Vitamin C in the body. Birth control pills Oral contraceptives Women who take these drugs often have low levels of folic acid and Vitamin B 6 in the blood. Dyazide/Thiazide Diuretics (water-eliminating) Taking diuretics often leads to a loss of potassium in the body. Tetracycline Antibiotic Calcium may interact with the effectiveness of the antibiotic. Avoid dairy products for two to three hours before and after taking the medicine. Lipitor/Zocor Statins (cholesterol-lowering drugs) Antioxidants (Vitamin A, C, E, B, folic acid) may interact with the drug by reversing its effect. Prednisone Corticosteroid The drug may increase appetite thus increasing nutrient intake. Lasix Diuretic (water-eliminating) The drug may decrease appetite thus decreasing nutrient intake.
  9. 9. Why is it so important to be aware of Interactions ? experience, solutions, results
  10. 10. What Essentially is one such CDSS ? experience, solutions, results
  11. 11. Key functions of CDSS <ul><li>Four key functions of electronic clinical decision support systems </li></ul><ul><li>&quot;Administrative: Supporting clinical coding and documentation, authorization of procedures, and referrals. </li></ul><ul><li>&quot;Managing clinical complexity and details: Keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care. </li></ul><ul><li>&quot;Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests. </li></ul><ul><li>&quot;Decision support: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific guidelines, and population-based management. &quot; </li></ul>experience, solutions, results
  12. 12. Types of CDSS <ul><li>There are two main types of CDSS </li></ul><ul><li>Knowledge-Based </li></ul><ul><li>NonKnowledge- Based </li></ul>experience, solutions, results
  13. 13. Features of a Knowledge-Based CDSS <ul><li>Most CDSS consist of three parts </li></ul><ul><li>The knowledge base </li></ul><ul><li>Interface engine, </li></ul><ul><li>Mechanism to communicate. </li></ul><ul><li>The knowledge base contains the rules and associations of compiled </li></ul><ul><li>data which most often take the form of IF-THEN rules. </li></ul><ul><li>If this was a system for determining drug interactions, then a rule might </li></ul><ul><li>be that IF drug X is taken AND drug Y is taken THEN alert user. </li></ul>
  14. 14. Features of a non-Knowledge-Based CDSS <ul><li>CDSS that do not use a knowledge base use a form of artificial </li></ul><ul><li>intelligence called Machine learning, which allow computers to learn </li></ul><ul><li>from past experiences and/or find patterns in clinical data. </li></ul><ul><li>Two types of non-knowledge-based systems are </li></ul><ul><li>Artificial neural networks </li></ul><ul><li>Genetic algorithms. </li></ul>
  15. 15. What happens at the Back office ? experience, solutions, results
  16. 16. experience, solutions, results
  17. 17. Example experience, solutions, results
  18. 18. Outcome -- Expert Recommendation(s) experience, solutions, results
  19. 19. Automated Results after a careful Evaluation experience, solutions, results
  20. 20. samples experience, solutions, results
  21. 21. Challenges with Adoption of CDSS experience, solutions, results
  22. 22. Word of Caution <ul><li>CDSS A Friend, philosopher ,a Guide </li></ul><ul><li> NOT a BOSS </li></ul><ul><li>NOT a Substitute for Doctors </li></ul>experience, solutions, results
  23. 23. Significance <ul><li>Quality of Treatment </li></ul><ul><li>Cost </li></ul><ul><li>Patient Safety </li></ul><ul><li>Doctors PAL </li></ul>experience, solutions, results
  24. 24. Examples for CDSS <ul><li>MYCIN  one of the first expert systems to be developed in the 1970s, </li></ul><ul><li>it does ethological diagnoses of bacterial diseases </li></ul><ul><li>CADUCEUS  a medical expert system that could diagnose 1000 diseases. </li></ul><ul><li>Internist-I  a computer-assisted diagnostic tool. </li></ul><ul><li>Dxplain  One another Dr Explain systems. </li></ul><ul><li>Iliad  uses Bayesian reasoning to calculate probabilities of various diagnoses </li></ul><ul><li>under consideration in internal medicine. It now covers around 1500 different diagnoses. </li></ul><ul><li>TheraDoc  A suite of real-time monitoring products as well as Infection prevention, mediation, and correction. TheraDoc uses a variety of standards compliant messaging taxonomies to work with currently existing software in the clinical setting to guide decision making as well as report trends in problems your institution is encountering. </li></ul><ul><li>Lifecom  Lifecom has developed an entirely new form of artificial intelligence technology and a supporting suite of knowledge development tools. The Lifecom technology portfolio includes novel knowledge extraction and management tools, the artificial intelligence engine, and a highly graphical user interface. </li></ul><ul><li>VisualDx  point-of-care diagnostic resource that allows clinicians to build patient-centric visual differential diagnoses based on the patient’s signs, symptoms, medical history, and more. Clinicians have immediate access to more than 17,000 images as well as expert-reviewed information for nearly 1,000 visually identifiable diseases, drug reactions, and infections represented in all age ranges and skin types. </li></ul><ul><li>RODIA  Relative Optical Density Image Analysis used in medical imaging, medical diagnostics, orthopedic and other medical disciplines. </li></ul>experience, solutions, results
  25. 25. Life without CDSS experience, solutions, results
  26. 26. A sample System experience, solutions, results
  27. 27. Sample continued (1)… experience, solutions, results
  28. 28. Sample ( Continued …(2)… ) experience, solutions, results
  29. 29. Limitations <ul><li>Preliminary evaluation was that changes in care provider practices were based on a single consultation, </li></ul><ul><li>A second potential limitation was the sampling method. </li></ul><ul><li>Risk of Coding , Testing , ( Needless to say …. BA....Role.... ) </li></ul><ul><li>Non – Certified CDSS </li></ul><ul><li>NOT sure of a Bulls eye every time </li></ul>experience, solutions, results
  30. 30. Future of CDSS experience, solutions, results
  31. 31. What is it built on ? experience, solutions, results
  32. 32. Some Doc’toons experience, solutions, results
  33. 33. Questions ? experience, solutions, results
  34. 34. experience, solutions, results [email_address] Sr.Business Analyst