Elets 7th Healthcare Leaders Forum 2017, New Delhi - Dr Lalit Singh, Director, Clinical Solutions & Product Strategy, Elsevier Health

1. Empowering Clinical
Leaders with Evidence
Based Clinical Decision
Support Solutions
EMPOWERING CLINICAL LEADERS
Dr Lalit Singh, M.S., FIAGES, MBA
Director Clinical Solutions and Strategy
Elsevier Health Solutions
7th Healthcare Leaders Forum, New Delhi

2. Why talk about Decision Support ?
Provided all the correct inputs, in a complex scenario a
machine is likely to help us make better decisions!

3. How does a physician start his day?
Available modes of transport
Shortest route/ Fastest route
Alternate routes in real time
Suggested time to work today
Nearby fuel stations/ coffee shops
Suggestions on opening and closing hours

4. Does it work in healthcare?

5. Once in the hospital…
Rapidly changing science
Technological innovations
Defunct CME system
Practicing quality care
Information overload
Information asymmetry

6. INCREASES THE VALUE of
our health services
Value = Quality/Cost
Role of Decision Support in Healthcare
IMPROVE PATIENT OUTCOMES
CONTROL THE COSTS OF CARE
MAXIMIZE PATIENT THROUGHPUT

7. What stops us from delivering value healthcare?
DECISION
VARIABILITY
QUALITY DATA
INFORMATION
KNOWLEDGE
WISDOM

8. Variable Cost, Quality, Efficiency Uniform Cost, Quality, Efficiency
VARIABILITY IN HEALTH & HEALTHCARE DELIVERY
DRIVES DOWN QUALITY, DRIVES UP COSTS,
AND REDUCES PATIENT THROUGHPUT

9. 9
In the high risk airline industry, reduced
variability is the cornerstone of safety.
What can healthcare industry learn from others?

10. 10
Henry Ford
His creation in 1913 of
the assembly line
revolutionized the
manufacturing across
the globe, dramatically
increasing productivity
and reducing costs…
Reduced variability was a
critical feature of Ford’s high
efficiency assembly line.
What can healthcare industry learn from others?

11. So how do we UNIFORMLY & SUSTAINABLY
REDUCE VARIABILITY IN HEALTHCARE DELIVERY
to decrease the cost and increase
the quality and productivity of our healthcare system?
CLINICAL
DECISION
SUPPORT

12. Solutions which empower providers & patients
with current, credible, evidence-based and
evidence-informed guidance
C
D
S

13. Pull
Push
SOLUTIONS
“Pull” CDS solutions allow care
providers to seek out and
consider current, credible,
evidence-based information
and guidance…
“Push” CDS solutions force care
providers to consider current,
credible, evidence-based information
and guidance…
The combination of “Push”
and “Pull” CDS solutions
most empowers all 4 providers

14. 14
Different types of Clinical Decision Supports
• Information support delivers
passive content which the user
has to interpret
• Action rules commonly used to
deliver alerts and reminders
• Computer-Interpretable
Guidelines (CIGs) provide
active decision support that:
 Customises content to
each patient
 Uses data from electronic
medical record when this is
available
 Is associated with
improved outcomes
 Actively interprets guidelines in the
light of patient data & prompts if
more data is needed
 Simplifies content by automatically
customising the guidelines
appropriate for each patient journey
over time
 Presents personalised reasons for
options, with arguments for &
against
 Records decisions selected & tasks
performed, along with variance
tracking

15. HIGH QUALITY, COST EFFICIENT HEALTHCARE
CONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based Content
Serves All Major Care Provider Types
Rapidly Delivered to All Points of Patient Care
Minimally Disruptive to Provider Workflow
PHYSICIANS
NURSES
OtherCare
Providers
PATIENTS
ORDER
SETS
(push)
REFERENCE
(pull)
CARE
PATHWAYS
(push & pull)
CARE
PLANNING
(push & pull)
REFERENCE
(pull)
eLEARNING
SKILLS
LMS
(push & pull)
CARE
PLANNING
(push & pull)
REFERENCE
(pull)
eLEARNING
SKILLS
LMS
(push & pull)
CARE
PATHWAYS
(push & pull)
ENGAGEMENT
& EDUCATION
(push & pull)
COMPLETE CDS SUITE FROM ELSEVIER

16. Make HIS easy to use and navigate!
Make HIS replicate their natural clinical workflow!
Make HIS help them make better decisions faster!
How do we ensure our clinicians adopt Clinical
Decision Support?
Give clinicians a compelling reason to adopt HIS!

17. 17
Clinical Decision Support for patients and Govt

18. 18

19. 19
Arezzo Clinical
Pathways in Primary
Care
Online
Health & Symptom
Checker
Telephone Triage
 Served more than 10
million patients per year
in England
 Accessed via web
online or mobile
application
 Decreased use of ER
services
 NHS24 in Scotland
 Extensions of service
planned for integration
with Scottish
Ambulance Service,
Emergency Care &
Palliative Care
Summary records
What is the degree of improvement?
 >90% of New Zealand
GPs
 Reduced admissions
for childhood asthma
by 50%
 Decreased stroke
 Improved HbA1C
levels in diabetes

20. 20

21. 21

22. 22

23. Reduced Never Events- One-year post implementation
results
(Median % reduction)
32%
Pressure Ulcers
16%
Falls
18%
Cather acq UTI
10%
Venous Cath acq Inf
CMS and Elsevier analysis
Elsevier Care Plans - Realized improvement

25. ELSEVIER
Over 25% of
the World’s
Clinical Content Serving over 20M
healthcare
professionals

26. 26
Thank You!