Clinical Decision Support at Partners Healthcare (Text Version)

On September 14, 2009, Blackford Middleton, MD, MPH, MSc made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (3741 KB).

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Slide 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

 

Slide 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!

 

Slide 3

Partners CDS

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

 

Slide 4

Medication ordering -- main screen

 

Slide 5

KnowledgeLink in the Workflow

 

Slide 6

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

 

Slide 7

CAD/DM Smart Form

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

 

Slide 8

CAD/DM Smart Form

Medication Orders
Lab Orders
Referrals
Handouts/Education

 

Slide 9

CAD Quality Dashboard

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

 

Slide 10

Discrepancy
Details

 

Slide 11

Serious Medication Error
Rates Before and After CPOE

Bates et. al. JAMA 1998.

 

Slide 12

Preliminary Results: Smart Form On Treatment Analysis

 

Slide 13

Patient Journal Causes
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:

 

Slide 14

An external repository of clinical content with web-based viewer

Search Criteria
Content Type...
Specialty

 

Slide 15

'Crowdsourcing' Knowledge Engineering

Personal Health
Information Network
Community ("Crowd")
Medical Professional
Rule builder
Knowledge
respository
Rule engine
Clin. Inf. System
Petter K. Risøe
HSPH HPM512 2009
Patient

 

Slide 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