A new way to practice medicine

Online Clinical Decision Support Systems:
A New Way to Practice Medicine
Pilar Fernandez Hermida
Director, Strategic Business Development
Pilar.hermida@wolterskluwer.com
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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
Answering all clinical
questions could change
5to8
patient management
decisions each day
of questions
go unanswered
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.
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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.
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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
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A New Way to Practice Medicine
What’s New/
Practice Changing
UpDates
10 500+
Clinical topics
5 400+
Drug entries
1 500+
Patient information
6 000+
Authors
CME/CPD
9
600+
Graded
Recommendations
29 000+
Graphics
160+
Medical Calculators
400 000+
Evidence Links (Medline)
22
Medical Specialties
eHEALTH – REVOLUTION IN THE MEDICAL PRAXIS
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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
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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
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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.
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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.
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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
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
ROI
90
=
days
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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.
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Accreditations
Accreditation Council for Continuing Medical Education
AMA PRA Category 1 Credit(s)™
Accreditation with Commendation
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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
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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
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Why a national focus?
National
Hospital Group
I
M
P
A
C
T
Hospital
Medical Team
Clinician
S
A
V
I
N
G
S
INTEGRATED CARE
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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
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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
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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
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Are you ready?
շնորհակալություն
Pilar.hermida@wolterskluwer.com
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Areas of Impact
Medical Education & Training
e-Health & Integration
Clinical Quality & Safety
Standardization of Healthcare
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