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Clinical Decision Support at Partners Healthcare

Clinical Decision Support at Partners Healthcare. Blackford Middleton, MD, MPH, MSc Corporate Director, Clinical Informatics R&D Chairman, Center for IT Leadership Partners Healthcare System Harvard Medical School Harvard School of Public Health. Overview: CDS Dimensions.

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Clinical Decision Support at Partners Healthcare

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  1. Clinical Decision Support at Partners Healthcare Blackford Middleton, MD, MPH, MSc Corporate Director, Clinical Informatics R&D Chairman, Center for IT Leadership Partners Healthcare System Harvard Medical School Harvard School of Public Health

  2. Overview: CDS Dimensions • Provider workflow • Lookup • Alert • Interrupt • Actionable • Documentation-centric • Population (Cohort) • Patient Relevance • Non-specific • Specific/tailored • Consumer • Lookup • Alert • Population (Cohort) • Methods • Inference methods (rules, etc.) • Temporal reasoning (protocols/pathways) • Values/Utilities (preferences: pt/provider) 5*2*3*3 = a minimum of 90 different approaches to CDS!

  3. Partners CDS • CPOE • Alerts & Reminders • Actionable CDS • Documentation-centric CDS • Population/cohort • Patient-directed CDS

  4. Medication ordering -- main screen

  5. KnowledgeLink in the Workflow

  6. Secure Messaging Patient Lists Schedule Clinical Alerts Knowledge Links Task Management Population Management

  7. CAD/DM Smart Form Smart View: Data Display Smart Documentation Smart Assessment, Orders, and Plan Assessment and recommendations generated from rules engine • Lipids • Anti-platelet therapy • Blood pressure • Glucose control • Microalbuminuria • Immunizations • Smoking • Weight • Eye and foot examinations

  8. CAD/DM Smart Form Medication Orders Lab Orders Referrals Handouts/Education

  9. CAD Quality Dashboard Targets are 90th percentile for HEDIS or for Partners providers Red, yellow, and green indicators show adherence with targets • Zero defect care: • Aspirin • Beta-blockers • Blood pressure • Lipids

  10. Discrepancy Details

  11. Serious Medication Error Rates Before and After CPOE Bates et. al. JAMA 1998.

  12. Preliminary Results: Smart Form On Treatment Analysis <0.001 <0.001 0.05 0.004 0.006 <0.001 <0.001 <0.001

  13. Patient Journal CausesProvider Activation More medication changes in visits after diabetes journal submission: 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. .

  14. An external repository of clinical content with web-based viewer Search Criteria Content Type… Specialty

  15. Rule builder Personal Health Information Network Science Knowledge respository Clin. Inf. System Rule engine ’Crowdsourcing’ Knowledge Engineering Patient Medical Professional Community (”Crowd”) Petter K. Risøe HSPH HPM512 2009

  16. Where are we? “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, MD bmiddleton1@partners.org www.partners.org/cird www.citl.org

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