clinical decision support at partners healthcare blackford middleton, md, mph, msc corporate...
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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
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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!
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Partners CDSPartners CDS
CPOECPOE Alerts & RemindersAlerts & Reminders Actionable CDSActionable CDS Documentation-centric CDSDocumentation-centric CDS Population/cohortPopulation/cohort Patient-directed CDSPatient-directed CDS
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Medication ordering -- Medication ordering -- main screenmain screen
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KnowledgeLink in the Workflow
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Secure Messaging
Task Management
PopulationManagement
Clinical Alerts
Schedule
Patient Lists
KnowledgeLinks
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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
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CAD/DM Smart FormCAD/DM Smart Form
Medication OrdersMedication Orders
Lab OrdersLab Orders
ReferralsReferrals
Handouts/EducationHandouts/Education
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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
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Discrepancy
Details
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Serious Medication Error Serious Medication Error Rates Before and After CPOERates Before and After CPOE
Bates et. al. JAMA 1998.
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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
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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:
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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
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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
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“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?