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Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century by Dr. Lalit Singh

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Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century by Dr. Lalit Singh, Director for Content & Product Strategy, Elsevier, India

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Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century by Dr. Lalit Singh

  1. 1. Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century EMPOWERING CLINICAL LEADERS Dr Lalit Singh, M.S., FIAGES, MBA Director Content and Product Strategy Elsevier Health Solutions
  2. 2. Life of a physician in 2016 From an era of lack of information to that of information overload!
  3. 3. 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
  4. 4. We are all trying to INCREASE THE VALUE of our health & healthcare… Value = Quality/Cost So, what are we trying to achieve? Improve Patient Outcomes Control the Costs of Care Maximize Patient Throughput
  5. 5. What Stands in the Way?
  6. 6. Variable Cost, Quality, Efficiency Uniform Cost, Quality, Efficiency VARIABILITY IN HEALTH & HEALTHCARE DELIVERY DRIVES DOWN QUALITY, DRIVES UP COSTS, AND REDUCES PATIENT THROUGHPUT
  7. 7. 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
  8. 8. 8 In the high risk airline industry, reduced variability is the cornerstone of customer safety.
  9. 9. 9 Henry Ford His creation in 1913 of the assembly line revolutionized the manufacturing across the globe, dramatically increasing productivity and reducing costs… Reduced variability was a critical feature of Ford’s high efficiency assembly line.
  10. 10. 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
  11. 11. Solutions which empower providers & patients with current, credible, evidence-based and evidence-informed guidance C D S
  12. 12. 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.
  13. 13. 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?
  14. 14. 14 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
  15. 15. HIGH QUALITY, COST EFFICIENT HEALTHCARE CONSISTENT, SUSTAINABLE, GOALCLINICAL DECISION SUPPORT STRATEGY
  16. 16. FOUNDATION HIGH QUALITY, COST EFFICIENT HEALTHCARE CONSISTENT, SUSTAINABLE, Current, Credible, Evidence-based Content Minimally Disruptive to Provider Workflow Rapidly Delivered to All Points of Patient Care Helps Record and Analyze Clinical Data for Providers and Policy Makers
  17. 17. HIGH QUALITY, COST EFFICIENT HEALTHCARE CONSISTENT, SUSTAINABLE, Current, Credible, Evidence-based Content Minimally Disruptive to Provider Workflow Rapidly Delivered to All Points of Patient Care Helps Record and Analyze Clinical Data for Providers and Policy Makers PHYSICIANS NURSES OtherCare Providers PATIENTS PILLARS
  18. 18. 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
  19. 19. HIGH QUALITY, COST EFFICIENT HEALTHCARE CONSISTENT, SUSTAINABLE, Current, Credible, Evidence-based Content Serves All Major Care Provider Types Rapidly Delivered to All Points of Patient Care Minimally Disruptive to Provider Workflow PHYSICIANS NURSES OtherCare Providers PATIENTS SOLUTIONS
  20. 20. HIGH QUALITY, COST EFFICIENT HEALTHCARE CONSISTENT, SUSTAINABLE, Current, Credible, Evidence-based Content Serves All Major Care Provider Types Rapidly Delivered to All Points of Patient Care Minimally Disruptive to Provider Workflow PHYSICIANS NURSES OtherCare Providers PATIENTS ORDER SETS (push) REFERENCE (pull) CARE PATHWAYS (push & pull) CARE PLANNING (push & pull) REFERENCE (pull) eLEARNING SKILLS LMS (push & pull) CARE PLANNING (push & pull) REFERENCE (pull) eLEARNING SKILLS LMS (push & pull) CARE PATHWAYS (push & pull) ENGAGEMENT & EDUCATION (push & pull) COMPLETE STRATEGY
  21. 21. ELSEVIER Over 25% of the World’s Clinical Content Serving over 20M healthcare professionals
  22. 22. 22 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 22
  23. 23. ELSEVIER Order Sets Radiology & Pathology Reference Solutions Physician Reference Solutions Nursing Reference Solutions (Generalist and Specialist) Clinical Skills for Nurses Patient Engagement Clinical Pathways
  24. 24. 24 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
  25. 25. 25 Physician reference Care Plans Drug information Pharma reference Nursing reference Nursing 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…
  26. 26. 26 • Less Costly • Fewer Contacts • Simpler IT Physician reference Care Plans Drug information Pharma reference Nursing reference Nursing 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
  27. 27. 27 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 •
  28. 28. 28 Thank You!

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