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Data in the Service of the Patient:Improving Patient Outcomes and Patient Safety with Better Data

Greg AdamsVice President

Wolters Kluwer | UpToDategregory.adams@wolterskluwer.com

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Doctors Have Clinical Questions

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.

Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a questionPhysicians have approximately 11 clinical questions a day

40%

of the time, the clinician knows the answer

Answering all clinical questions could

change

5 to

8 patient management

decisions each day

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Staying on top of Medical KnowledgeIn 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.

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Clinical Decision Support: Getting It Right

In the Right

Context & Format

The Right

Guidance

At the Right Time

The Right

Decision

5We invite you to review the study data yourself: http://www.uptodate.com/home/research

Over 60independent studies

Have shown that UpToDate has a direct impact on quality of care and clinical outcomes such as a reduction of

complications,

mortality,

and costs.

The Most studied Clinical Decision Support System

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UpToDate Changes Clinical Decisions

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.

37%

Researchers at Singapore’s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions…

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Use of UpToDate Associated with Improved Outcomes

1. Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospitals.

2. Bonis PA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length ofstay among Medicare beneficiaries in acute care hospitals in the US. Int J Med Inform 2008; 77:745.

Significantly shortens length of

stay

Significantly lowers complication rates

Significantly lowers adverse outcome rates

Solucient1 studied the impact of UpToDate on length of stay, complications, and patient safety2

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Researchers at Harvard University FindUpToDate Associated with Improved Outcomes

Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85.

Use of UpToDate Associated with...

Improved Quality Every condition on Hospital Quality Alliance

MetricsShorter Lengths of Stay 372 000 days over 1 year

Lower Mortality Rates 11 500 lives over 3 years

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Economic Impact of UpToDate at Salford Royal NHS Foundation Trust

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

Benefits Included: Staff productivity Diagnostic test

efficiencies Improvements in the

quality of care

Forrester Research found Salford Royal NHS Foundation Trust (SRFT)

recovered the costs of UpToDate in 90 days

90=

ROI

days

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UpToDate has national contracts with the governments of Norway (2010), Iran (2011), Spain (2013), Saudi Arabia (2013), Oman (2014), and Jordan (2015) to standardize care based on UpToDate content.In other countries, such as the USA, The Netherlands, Switzerland, or Luxembourg, UpToDate is used in all hospitals.

UpToDate around the world30 000 hopitals and clinics in 174 countries use UpToDate

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Integrating Clinical Decision Support in the Workflow

In the Right

Context & Format

The Right

Guidance

At the Right Time

The Right

Decision

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The Most Valuable HIT Initiative for Patient Care

Source: UpToDate individual subscriber survey 2012

Which IT initiative produces the greatest benefitto the quality and safety of patient care?

Order sets

CPOE

Patient ed

Alerts/reminders

eRx

EHR system

UpToDate CDS

20 30 40 50 60

26.53

31.35

32.68

33.41

36.28

37.39

54.31

Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127)

Is important to patient

careEnhances

satisfaction with their EHR

Encourages utilization

of their EHR

Increased Clinician Satisfaction with the EHR

Source: July 2011 Clinicians Survey N = 1228

Users said that having UpToDate embedded in their EHR

2011 91%

2011 89%

2011

40%

Is important to patient

careEnhances

satisfaction with their EHR

Encourages utilization

of their EHR

Increased Clinician Satisfaction with the EHR

Source: July 2015 Clinicians Survey N = 2526

Users said that having UpToDate embedded in their EHR

2015 93%

2015 91%

2015

47%

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Conclusion

Based on our experience in over 30 000 hospitals around the world, we are convinced that full use of REAL Integrated Clinical Decision Support would help:

Improve quality of care Improve medical knowledge Reduce complications Reduce errors

This will help save more lives This will help save more money.

Better Decisions,Better Care