Evidence Based Clinical Decision Support – An Enabler for Clinicians in 21st Century by Dr. Lalit Singh, Director for Content & Product Strategy, Elsevier, India

1. Evidence Based
Clinical Decision
Support – An Enabler
for Clinicians in 21st
Century
EMPOWERING CLINICAL LEADERS
Dr Lalit Singh, M.S., FIAGES, MBA
Director Content and Product Strategy
Elsevier Health Solutions

2. Life of a physician in 2016
From an era of lack of
information to that of
information overload!

3. Why talk about Clinical Decision Support ?
Provided all the correct inputs in a complex scenario, a
machine is likely to make better decisions than an individual

4. We are all trying to
INCREASE THE VALUE of
our health & healthcare…
Value = Quality/Cost
So, what are we
trying to achieve?
Improve Patient Outcomes
Control the Costs of Care
Maximize Patient Throughput

5. What Stands in the Way?

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

7. The Damage Caused by
Variability in the Delivery
of Healthcare…
400,000 PREVENTABLE
DEATHS ANNUALLY
10,000 PREVENTABLE SERIOUS
COMPLICATIONS DAILY
12,000,000 AMBULATORY DIAGNOSTIC
ERRORS, 50% POTENTIALLY SERIOUS
Data from The US

8. 8
In the high risk airline industry,
reduced variability is the
cornerstone of customer safety.

9. 9
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.

10. 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

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

12. An Electronic Medical Record
IS NOT
in-and-of itself a
Clinical Decision Support solution!
An EMR is an efficient, consistent
way to deliver CDS solutions
to physicians, nurses,
pharmacists, other traditional
care providers, and to patients.

13. The key to better adoption of HIS among physicians is
to give them a compelling reason to do so!
How do we ensure our clinicians adopt
Clinical Decision Support?

14. 14
Different types of Clinical
Decision Support (CDS)
• 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,
GOALCLINICAL DECISION SUPPORT STRATEGY

16. FOUNDATION
HIGH QUALITY, COST EFFICIENT HEALTHCARE
CONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based Content
Minimally Disruptive to Provider Workflow
Rapidly Delivered to All Points of Patient Care
Helps Record and Analyze Clinical Data for Providers and Policy Makers

17. HIGH QUALITY, COST EFFICIENT HEALTHCARE
CONSISTENT, SUSTAINABLE,
Current, Credible, Evidence-based Content
Minimally Disruptive to Provider Workflow
Rapidly Delivered to All Points of Patient Care
Helps Record and Analyze Clinical Data for Providers and Policy Makers
PHYSICIANS
NURSES
OtherCare
Providers
PATIENTS
PILLARS

18. 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

19. 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
SOLUTIONS

20. 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 STRATEGY

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

22. 22
Elsevier’s Mission: Moving Knowledge into Practice
The intersection of trusted content and workflow-friendly solutions
• Over 100 years of trusted content
• Deep expertise across all forms of
clinical content
• Solutions centered around clinical
workflows
• Partnerships to ensure integration of
content with technology
22

23. ELSEVIER
Order Sets
Radiology
& Pathology Reference
Solutions
Physician Reference
Solutions
Nursing Reference Solutions
(Generalist and Specialist)
Clinical Skills for Nurses
Patient Engagement
Clinical Pathways

24. 24
Elsevier suite of applications supported by the World’s Best Content
Patient
Focused
Radiology & pathology
reference and CDS
solutions
Easy to work with,
user friendly
ambulatory order sets
Personalised care
pathways
Impactful “low value”
and “risk” alerts
Physician & pharmacist
reference and CDS solutions
Customizable, multi-
language & literacy
level patient education
solutions
The most powerful
patient data collection
solution
Nursing Skills, eLearning,
learning management
systems, reference & Care
Plan Solutions

25. 25
Physician
reference
Care Plans
Drug
information
Pharma
reference
Nursing reference
Nursing education
Patient
engagement
Order sets
You
Non-integrated, non-communicative individual products fail to
communicate or integrate and often provide conflicting guidance!
• More Costly
• Too Many Contacts
• More IT Challenges
WHY “BEST IN CLASS” PRODUCTS CAN’T DRIVE VALUE…

26. 26
• Less Costly
• Fewer Contacts
• Simpler IT
Physician
reference
Care Plans
Drug
information
Pharma
reference
Nursing reference
Nursing education
Patient
engagement
Order sets
ITERATIVE solutions that
COMMUNICATE, INTEGRATE,
and provide CONSISTENT guidance!
“BEST IN SUITE” SOLUTIONS DRIVE VALUE.
The problem has been with integration of
our best in breed applications
Dr Mammen, CMC Vellore

27. 27
Building blocks of Arezzo guidelines
•Arezzo computer-interpretable guidelines (CIGs) are made up of
• Tasks and collections of tasks
• Data Items
•Tasks and data items have attributes
• Define the behaviour of the guideline during enactment by Arezzo Performer
•Arezzo has four basic types of tasks
• Enquiries; Decisions; Actions; Plans
• CIGs are made up of collections of these four basic types
• Keystone is the parent type, which is used to link CIGs together
•

28. 28
Thank You!