Clinical Decision Support at Partners Healthcare Blackford Middleton, MD, MPH, MSc Corporate...
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Clinical Decision Clinical Decision Support at Partners Support at Partners Healthcare Healthcare Blackford Middleton, MD, MPH, MSc Blackford Middleton, MD, MPH, MSc Corporate Director, Clinical Informatics Corporate Director, Clinical Informatics R&D R&D Chairman, Center for IT Leadership Chairman, Center for IT Leadership Partners Healthcare System Partners Healthcare System Harvard Medical School Harvard Medical School Harvard School of Public Health Harvard School of Public Health
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Transcript of Clinical Decision Support at Partners Healthcare Blackford Middleton, MD, MPH, MSc Corporate...
Clinical Decision Support at Clinical Decision Support at Partners HealthcarePartners HealthcareBlackford Middleton, MD, MPH, MSc Blackford Middleton, MD, MPH, MSc
Corporate Director, Clinical Informatics R&DCorporate Director, Clinical Informatics R&DChairman, Center for IT LeadershipChairman, Center for IT Leadership
Partners Healthcare SystemPartners Healthcare SystemHarvard Medical SchoolHarvard Medical School
Harvard School of Public HealthHarvard School of Public Health
Overview: Overview: CDS DimensionsCDS Dimensions
Provider workflowProvider workflow– LookupLookup
– Alert Alert
– Interrupt Interrupt
– ActionableActionable
– Documentation-centricDocumentation-centric
– Population (Cohort)Population (Cohort)
Patient RelevancePatient Relevance– Non-specificNon-specific
– Specific/tailoredSpecific/tailored
ConsumerConsumer– LookupLookup
– AlertAlert
– Population (Cohort)Population (Cohort)
MethodsMethods– Inference methods (rules, etc.)Inference methods (rules, etc.)
– Temporal reasoning Temporal reasoning (protocols/pathways)(protocols/pathways)
– Values/Utilities (preferences: Values/Utilities (preferences: pt/provider)pt/provider)
5*2*3*3 = a minimum of 90 different approaches to CDS!5*2*3*3 = a minimum of 90 different approaches to CDS!
Partners CDSPartners CDS
CPOECPOE Alerts & RemindersAlerts & Reminders Actionable CDSActionable CDS Documentation-centric CDSDocumentation-centric CDS Population/cohortPopulation/cohort Patient-directed CDSPatient-directed CDS
Medication ordering -- Medication ordering -- main screenmain screen
KnowledgeLink in the Workflow
Secure Messaging
Task Management
PopulationManagement
Clinical Alerts
Schedule
Patient Lists
KnowledgeLinks
CAD/DM Smart FormCAD/DM Smart Form
Smart View: Data Display
Smart View: Data Display
Smart Assessment, Orders, and Plan
Smart Assessment, Orders, and Plan
Assessment and recommendations generated from rules engine
Assessment and recommendations generated from rules engine
Smart Documentation
Smart Documentation
• Lipids• Anti-platelet therapy• Blood pressure• Glucose control• Microalbuminuria• Immunizations• Smoking • Weight• Eye and foot examinations
• Lipids• Anti-platelet therapy• Blood pressure• Glucose control• Microalbuminuria• Immunizations• Smoking • Weight• Eye and foot examinations
CAD/DM Smart FormCAD/DM Smart Form
Medication OrdersMedication Orders
Lab OrdersLab Orders
ReferralsReferrals
Handouts/EducationHandouts/Education
CAD Quality DashboardCAD Quality Dashboard
Targets are 90th percentile for HEDIS or for Partners providers
Targets are 90th percentile for HEDIS or for Partners providers
Zero defect care: • Aspirin• Beta-blockers• Blood pressure• Lipids
Zero defect care: • Aspirin• Beta-blockers• Blood pressure• Lipids
Red, yellow, and green indicators show adherence with targets
Red, yellow, and green indicators show adherence with targets
Discrepancy
Details
Serious Medication Error Serious Medication Error Rates Before and After CPOERates Before and After CPOE
Bates et. al. JAMA 1998.
Preliminary Results: Preliminary Results: Smart Form On Treatment AnalysisSmart Form On Treatment Analysis
<0.001
<0.001
<0.001
<0.001
<0.001
0.05
0.004
0.006
Patient Journal CausesPatient Journal CausesProvider Activation Provider Activation
Grant RW et al. Practice-linked Online Personal Health Records for Type 2 Diabetes: A Randomized Controlled Trial. Arch Intern Med. 2008 Sep 8;168(16):1776-82. .
More medication changes in visits after diabetes journal submission:
An external repository of clinical An external repository of clinical content with web-based viewercontent with web-based viewer
Search CriteriaSearch CriteriaContent Type…Content Type…
SpecialtySpecialty
Community (”Crowd”)Medical Professional
Personal Health
Information NetworkScience
Rule builder
Knowledge
respository
Rule engine
Clin. Inf. System
Petter K. RisøeHSPH HPM512 2009
’’Crowdsourcing’ Crowdsourcing’ Knowledge EngineeringKnowledge Engineering
Patient
“I conclude that though the individual physician is not perfectible, the system of care is, and that the computer will play a major part in the perfection of future care systems.”
Clem McDonald, MD NEJM 1976
Thank you!Blackford Middleton, [email protected]/cirdwww.citl.org
Where are we?Where are we?
