Just-in-time Decision-Support for Improving and Optimising Professional Practices. Geissbühler A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Just-in-time Decision-
Support for Improving and
Optimising Professional
Practices
Prof. Antoine Geissbühler, MD
Geneva University Hospitals

2. 1999: to err is human

3. 2005: e-iatrogenesis
Han et al., Pediatrics 2005;116:1506-1512

4. Meaningful integration in the care
processes

5. Geneva University Hospitals
• 2'200 beds
• 3 campuses, 30 smaller sites
• Primary, secondary and
tertiary care
• 50'000 admissions/year
• 800'000 outpatient visits/year
• 10'000 collaborators
• 1‘500 physicians
• 3'500 nurses

7. Considering today's
serum creatinine level,
I recommend that you
adjust the dosage of
intravenous gentamicin
to 80mg every 24 hours
(and check its blood
level in three days)

9. • Knowledge validation
Activating and operationalization
new • Clinical decision-
support tools
knowledge • Patient simulators
Learning
from care
• Information collection, data
aggregation
• Knowledge discovery
• Population-level
surveillance Supporting care
production
• Electronic health record
• CPOE and clinical decision-support tools
• Collaborative care pathways
• Health information exchanges &
telemedicine

10. A "learning institution"
information,
knowledge
just in time
integration, decisions,
at the point
interpretation of care
actions
data,
signals

11. A "learning institution"
Institutional
Patient record knowledge
- visualisation management:
- data capture - creation
- links to KB - validation
- distribution
information,
knowledge
Knowledge
discovery,
just in time
data mining integration, decisions,
at the point
interpretation of care
actions
data,
Alerts and signals Provider
notifications order entry,
decision
Care planning support
and Scheduling and
documentation optimization

12. Integrating information

13. From documentation to coordination

14. Collaborative care: clinical pathways

15. Connecting with the real world

16. Driving decisions with clinical data

17. Discovering knowledge: @neurIST

18. DEBUG-IT