Online Clinical Decision Support Systems: A New Way to Practice Medicine Pilar Fernandez Hermida Director, Strategic Business Development Pilar.hermida@wolterskluwer.com 0
Doctors Have Clinical Questions Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a question Physicians have approximately 11 clinical questions a day 60 % of questions go unanswered Answering all clinical questions could change 5to8 patient management decisions each day Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218; Osheroff, JA. Ann Intern Med 1991:575; Ely, JW. J Am Med Inform Assoc 2005; 12:217; Gorman, PN. Med Decis Making 1995; 15:113. 1
Staying on top of Medical Knowledge In 1965, only 39 randomized trials were published in medicine. In 2011, there were 21 000, which poses a seemingly insurmountable information challenge for clinical professionals who want to stay current with important information. There is too much information to be able to manage or digest. 2
What are clinical decision support systems? UpToDate is the premier evidence-based clinical decision support system. For over 20 years clinicians have trusted UpToDate to answer their clinical questions at the point of care. UpToDate s team of over 6000 top-expert authors from 50 countries synthesize the most recent medical information into evidence-based and actionable recommendations that clinicians trust to make the right patient management decisions during the consultation. This helps doctors to: Answer rapidly and effectively to their clinical questions. Change doctor s decisions Save doctors time Advance medical education Improve the quality of care 3
A New Way to Practice Medicine What s New/ Practice Changing UpDates 10 500+ Clinical topics 5 400+ Drug entries 1 500+ Patient information CME/CPD 29 000+ Graphics 160+ Medical Calculators 400 000+ Evidence Links (Medline) 22 Medical Specialties 6 000+ Authors ehealth REVOLUTION IN THE MEDICAL PRAXIS 9 600+ Graded Recommendations 4
The most studied clinical decision support system 60+ Independent research studies associate use of UpToDate to: Fast and efficient answers to clinical questions Change of patient management decisions Improve outcomes Advancement of continuous medical education. Better Quality of Care 5
Clinicians Save Time 100% 75% 50% 77% 80% 80% 86% 86% 86% 86% 95% 100% 100% 91% 25% 0% Percentage of users who report that UpToDate saves them time in answering clinical questions 6
UpToDate Changes Clinical Decisions 37% Researchers at Singapore s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions 37% of the time. Phua J, See KC, Khalizah HJ, et al. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53:116. 7
Harvard University Finds use of UpToDate associated with Improved Outcomes Use of UpToDate Associated with... Improved Quality Every condition on Hospital Quality Alliance Metrics Shorter Lengths of Stay 372 000 days over 1 year Lower Mortality Rates 11 500 lives over 3 years Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85. 9
Impact: Millions of decisions changed in 2014 # of searches 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0 276 551 378 searches : about 90m of changed decisions (est.)
Economic Impact of UpToDate Forrester Research found Salford Royal NHS Foundation Trust (SRFT) recovered the costs of UpToDate in 90 days Benefits Included: Staff productivity Diagnostic test efficiencies Improvements in the quality of care ROI = 90 days Source: November 2011, Forrester Research: The Total Economic Impact Of UpToDate s Clinical Decision Support System For Healthcare Institutions: A Case Study Of Salford Royal NHS Foundation Trust in the UK 11
Using UpToDate Increases Medical Knowledge 20 Minutes a day = Equals an Entire Year of Residency McDonald, F, Zeger, SC, Kolars, JC. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency J Gen Intern Med 2007. 12
Accreditations Accreditation Council for Continuing Medical Education AMA PRA Category 1 Credit(s) Accreditation with Commendation American Academy of Family Physicians American Academy of Nurse Practitioners American Academy of Pediatrics American Academy of Physician Assistants American College of Emergency Physicians American College of Obstetricians and Gynecologists American Osteopathic Association The Austrian Academy of Physicians Federación Mexicana de Colegios de Obstetricia y Ginecología Colegio de Medicina Interna de México College of Family Physicians of Canada Postgraduate Medical Training Bodies in Ireland Japan Primary Care Association Royal College of Physicians and Surgeons of Canada Royal Australasian College of Physicians Royal Australasian College of General Practitioners Royal Australian and New Zealand College of Obstetricians and Gynecologists Australasian College for Emergency Medicine Singapore Medical Council Dubai Health Authority Oman Medical Specialty Board Qatar Supreme Council of Health Kuwait Institute for Medical Specialization South Africa Health Professions Council Saudi Commission for Health Specialties Qatar Council for Healthcare Practitioners 13
UpToDate in the world More than 30 000 hospitals in 174 countries use UpToDate UpToDate has national contracts with the governments of Norway, Iran, Spain, Saudi Arabia, Jordan and Oman. In countries such as Luxemburg, the Netherlands, and Switzerland UpToDate is used country-wide. UpToDate is used in over 70% of the hospitals in the USA and Canada RESOURCE STANDARIZATION = HEALTHCARE DEMOCRACY 16
Why a national focus? National I M P A C T Hospital Group Hospital Medical Team Clinician S A V I N G S INTEGRATED CARE 17
mhealth : change of paradigm 77% of clinicians use a Smartphone at work 70% of clinicians resort to some form of clinical decision support system mhealth in Armenia 115% penetriation rate (2014) 4M users (2014) 45%* frequent internet users http://www.budde.com.au/research/armenia-telecoms-mobile-and-internet.html 18
One Roadmap for the Future The European EMR Adoption Model in 7 Stages to Highest Quality in Patient Care Paperless patient record environment for highest quality of care, data continuity & full HIE Full electronic clinical decision support, and highest medication safety Completely electronic diagnostic image management Electronic order entry with decision support and result reporting Clinical ordering and documentation especially nursing care A patient-centered electronic data repository Electronic diagnostic and pharmacy department information
Potential benefits for Armenia Better Quality of Care: Shorter stays; Reduction of complication rates, errors and undesirable outcomes > Patient Safety. Hospital Operational Efficiency: Sustainable costs and proven ROI. Territorial Cohesion: Bridging the healthcare gap (across the geography and amongst the different institutions) > Integrated healthcare. Capacity Building: Improvement of skills and continous medical education (CME) > Staff satisfaction, compliance and better quality of care. Universal access: Egalitarian & sustainable InfOstructure : Unlimited usage 24/7, Anywhere, Any Device. Easy to embed into EMR system. Adoption: Easy to deploy & widely adopted solution with award-winning user-friendly interfaces > Quick win in ehealth strategy. Armenia as regional reference in the adoption of innovative and transformational technologies in healthcare 20
Clinical Decision Support: Getting It Right In the Right Context & Format The Right Guidance At the Right Time The Right Decision 21
Are you ready?
շնորհակալություն Pilar.hermida@wolterskluwer.com 23
Areas of Impact Medical Education & Training Clinical Quality & Safety e-health & Integration Standardization of Healthcare 24