Clinical Decision Support at Partners Healthcare

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Clinical Decision Support at Partners Healthcare

• Blackford Middleton, MD, MPH, MSc
• Corporate Director, Clinical Informatics RD
• Chairman, Center for IT Leadership
• Partners Healthcare System
• Harvard Medical School
• Harvard School of Public Health

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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)

5233 a minimum of 90 different approaches to
CDS!
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Partners CDS

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

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Medication ordering -- main screen
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KnowledgeLink in the Workflow
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Secure Messaging
Patient Lists
Schedule
Clinical Alerts
Knowledge Links
Task Management
Population Management
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CAD/DM Smart Form
Smart View Data Display
Smart Assessment, Orders, and Plan
Smart Documentation
Assessment and recommendations generated from
rules engine

• Lipids
• Anti-platelet therapy
• Blood pressure
• Glucose control
• Microalbuminuria
• Immunizations
• Smoking
• Weight
• Eye and foot examinations

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CAD/DM Smart Form
Medication Orders
Lab Orders
Referrals
Handouts/Education
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CAD Quality Dashboard
Targets are 90th percentile for HEDIS or for
Partners providers
Red, yellow, and green indicators show adherence
with targets

• Zero defect care
• Aspirin
• Beta-blockers
• Blood pressure
• Lipids

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Discrepancy
Details
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Serious Medication Error Rates Before and After
CPOE
Bates et. al. JAMA 1998.
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Preliminary Results Smart Form On Treatment
Analysis
lt0.001
lt0.001
0.05
0.004
0.006
lt0.001
lt0.001
lt0.001
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Patient Journal CausesProvider Activation
More medication changes in visits after diabetes
journal submission
Grant RW et al. Practice-linked Online Personal
Health Records for Type 2 Diabetes A Randomized
Controlled Trial. Arch Intern Med. 2008 Sep
8168(16)1776-82. .
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An external repository of clinical content with
web-based viewer
Search Criteria
Content Type
Specialty
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Crowdsourcing Knowledge Engineering
Patient
Community (Crowd)
Medical Professional
Petter K. Risøe HSPH HPM512 2009
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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_at_partners.org www.partners.org/cird
www.citl.org