This document discusses delivering clinical knowledge and guidance directly into healthcare workflows through clinical decision support (CDS). CDS aims to provide clinicians and patients with intelligently filtered, situation-specific information to enhance patient care. The goal is to repurpose existing clinical content from various sources and deliver the most precise and useful information for each workflow and information need. Physician information needs were analyzed from query data to develop an ontology of needs. Content is curated, indexed as discrete facts, and tailored for specific situations by matching it to patient data, workflows, and information needs. Knowledge delivery aims to integrate actionable tools and options directly into clinical systems like EHRs.

1. Delivering Knowledge into the Workflow
Jonathan Teich – AMDIS fall symposium, Sept. 30, 2013

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The Guy Who Knows

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New Condition = angina FAQs
How do I
confirm Dx?
Gen info
about angina
What are the
treatments?
What can I
expect? (clin
course/hazards
Info about
relevant MEDS
Info about
relevant procedures
Disposition, re:
admission criteria
Nitroglycerin
Beta blockers
Antiplatelet agents
Heparin
Cardiac cath
PTCA (stents)
Angina Order
Set:
Meds, O2,
Monitoring, x-ray,
labs
1. Order
Clopidogrel
FAQs
ALERT:
Don’t use in
Patients taking
WarfarinCheck rules
Info about
med
2. Procedure
needed
Procedure
advice
Information needs
•

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Clinical Decision Support
• CDS = “Providing clinicians or patients with clinical
knowledge and patient-related information,
intelligently filtered or presented at appropriate
times, to enhance patient care.”
• Stuff you learned once from books and journals,
reformatted and delivered when and how you need
them in practice
– Tailored to the current situation
– Delivered for best action

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Like a GPS, CDS supplies
information tailored to the current
situation, and organized for
maximum value.

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Goal
We seek to repurpose the content available in
books, journals, guidelines, etc.,
to deliver the most precise information and the
most useful form
For any given workflow and information need

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Physician information needs and queries
• Data about hundreds of thousands of queries to
MDConsult, First Consult
• Synthesized ontology of information needs
7

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Smart Content – turning content into
action
1. Content
• Curated,
maintained
2. Content
indexed as
discrete,
reusable
facts
3. Content
tailored to
the situation
• Matched to
insertion points,
patient data,
information
need
configuration
4.
Actionable
tools
• External,
service-based
• Integrated into
EHR screens
8

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12
Patient-specific workup options:
diagnostic and therapeutic
choices

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13
*

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Summary
• Knowledge is a parallel to data – they both have
ontologies, coding, and could have standards
• Knowledge can be applied in different forms for
different workflows and different users
• Need to balance working with EHRs, SMART sidecars,
standalone references, smartphones – for the best
clinical result
j.teich@elsevier.com
jteich@harvard.edu