Overview'of'Clinical'Decision' Support'and'Knowledge' Management'
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1 Overview'of'Clinical'Decision' Support'and'Knowledge' Management' Roberto'A.'Rocha,'MD,'PhD,'FACMI' Clinical'Informa9cs'Director,' Partners'eCare,'Partners'Healthcare'System' Assistant'Professor'of'Medicine' Division'of'General'Internal'Medicine'and'Primary'Care,'Department'of' Medicine,'Brigham'and'Women s'hospital,'harvard'medical'school' Big%Data%in%Healthcare:%The%Impact%on%Healthcare%Quality,%Cost%and%Access%in%China% =%April%18=19,%2016%=%%
2 Overview' Background' Clinical'Decision'Support'(CDS)'modali9es' Examples'from'Partners'HealthCare' Knowledge'Management'(KM)' KM'program,'challenges,'opportuni9es' Assets'and'tools'used'at'Partners'HealthCare' Conclusions' Successful'program,'care'workflow,'sharing'
3 Modalities'of'CDS' Reference'knowledge'selec%on(and'retrieval( e.g.,'infobuqons,'crawlers'(indexing)' Informa9on'aggrega%on(and'presenta%on( e.g.,'summaries,'reports,'dashboards' Data'entry(assistance( e.g.,'forcing'func9ons,'calcula9ons,'evidencerbased'templates'for' ordering'and'documenta9on' Event(monitors( e.g.,'alerts,'reminders,'alarms' Care'workflow(assistance( e.g.,'protocols,'care'pathways,'prac9ce'guidelines' Descrip%ve(or'predic%ve(analy9cs' e.g.,'diagnosis,'prognosis,'treatment'planning,'treatment'outcomes' 3(
4 Informa9on'about' Depression ' CDS:(infobu?ons(
5 CDS:'alerts'for'medication'ordering' 5(
6 CDS:'interruptive'alert'with'action' Clinician'must(cancel'current' order'or'discon9nue' prerexis9ng'order'
7 CDS:'geriatric'medication'dosing' 7(
8 CDS:'preventive'care'reminders' 8(
9 CDS'key'challenges' Reliable'change(management( Revisions'with'preserva9on'of'dependencies' Efficient'propaga9on'of'changes' Preserva9on'of'meaning'(intent)' High'scalability( Ability'to'handle'mul%ple(clinical'condi9ons'with' reasonable'development'and'maintenance'costs' Adop9on'of'distributed'and'collabora%ve(cura%on( framework'(easy'to'create'and'deploy)' Maximize'reusability'and'maintainability'
10 KNOWLEDGE'MANAGEMENT'(KM)'
11 KM'Program' Systema%c(and'sustainable(acquisi9on,'adapta9on' (localiza9on),'and'management'of'knowledge'assets' for'different' modali9es 'of'cds' Includes'the'adapta%on(of' reference 'knowledge'to' reflect'local'and'ins9tu9onal'requirements,' resources,'and'priori9es' Follows'a'wellRdefined'lifecycle,'including'specific' stages'for'documenta9on,'tes9ng,'and'monitoring' ' supported'by'integrated'set'of'tools'and'resources' Rocha'RA,'Maviglia'SM,'Sordo'M,'Rocha'BH.'Clinical'knowledge'management'program.'In:'Greenes'RA,'editor.'Clinical' Decision'Support'R'The'Road'to'Broad'Adop9on'(Second'Edi9on).'Burlington:'Academic'Press;'2014.'p.'773R817'
12 Implementation'of'CDS'modalities( CDS'modality( Types'of'Knowledge'Assets( 1.'Information' selection'and' retrieval' Reference' 2.'Information' aggregation'and' presentation' 3.'Data'entry' assistance' 4.'Event'monitors' 5.'Care'workflow' assistance' 6.'Descriptive'or' predictive'modeling' Complexity' Cost' Actionable' Executable' Availability' Maintainability' 12(
13
14 Inventory'of'Knowledge'Assets' Managed'Centrally'at'Partners'(1/2)' Rocha'RA,'Maviglia'SM,'Sordo'M,'Rocha'BH.'Clinical'knowledge'management'program.'In:'Greenes'RA,' editor.'clinical'decision'support'r'the'road'to'broad'adop9on'(second'edi9on).'burlington:'academic' Press;'2014.'p.'773R817'
15 Inventory'of'Knowledge'Assets' Managed'Centrally'at'Partners'(2/2)' Rocha'RA,'Maviglia'SM,'Sordo'M,'Rocha'BH.'Clinical'knowledge'management'program.'In:'Greenes' RA,'editor.'Clinical'Decision'Support'R'The'Road'to'Broad'Adop9on'(Second'Edi9on).'Burlington:' Academic'Press;'2014.'p.'773R817'
16 Knowledge'Engineering'challenges' LaborRintensive'acquisi%on(process'(SMEs)' Inability'to'achieve'proper'domain(coverage( Rudimentary'tools(&'resources( Costly(and'inefficient(maintenance' WellRtrained'personnel'equipped'with'efficient'tools'and' processes' Distributed'and'collabora%ve(ac%vi%es( 'i.e.'coopera9on' across'teams'and'ins9tu9ons' Common'tools,'processes,'and'standards'
17 Implementation'challenges' Data(availability' Data'not'coded,'coded'inconsistently,'not'enough'detail'(codes)' Large'number'of'dependencies'(frequency'of'changes)( Data'defini9ons,'classifica9ons,'EHR'configura9on,'new'evidence' Rudimentary'tools((edi9ng)' Incorrect'logic,'missing'values,'related'rules,'automated'valida9on' Labor'intensive'tes%ng( Posi9ve'and'nega9ve'tests,'regression'tes9ng,'automated'tes9ng' EHR(system'or'integrated'CDS'engine' Limited'integra9on'op9ons,'complex'configura9on,'peculiar'features' Rocha'RA,'Maviglia'SM,'Sordo'M,'Rocha'BH.'Clinical'knowledge'management'program.'In:'Greenes'RA,'editor.'Clinical' Decision'Support'R'The'Road'to'Broad'Adop9on'(Second'Edi9on).'Burlington:'Academic'Press;'2014.'p.'773R817'
18 Basic'KM'scenario:'Portal' WebRbase'portal'(intranet/Internet)' Open(access(to'a'complete'inventory'of'knowledge' assets'created'and/or'used'(mul9ple'types)' Asset'metadata,'including'iden9fica9on,'provenance,' lifecycle,'designa9ons'(labels'and'names),'and' classifica9ons' Essen9al'documenta%on((detailed'specifica9ons)' Enables'process'transparency(and'effec9ve' collabora%on((including'reuse)'
19 Portal'Overview'
20 CONCLUSIONS'
21 CDS:'Care'workflow'assistance' (Registra%on)' (Triage)( knowledge'retrieval,'data'entry'assistance,' event'monitors' Protocol( eligibility( Clinician( preference( Pneumonia( protocol( (Ini%al(Assessment)( data'entry'assistance,'knowledge'retrieval,' order'entry'assistance,'event'monitors' (Complete(Assessment)' informa9on'presenta9on,'data'entry'assistance,' knowledge'retrieval,'event'monitors' Protocol( stra%fica%on( Pa%ent( preferences( 2 nd( Episode( (Analysis(&(Plan)' knowledge'retrieval,'order'entry'assistance,' informa9on'aggrega9on,'data'entry'assistance,' event'monitors' Appropriate( Abx( CoTmorbidi%es(
22 CDS'has'to'follow'the'patient' Clinical'systems'might'have'very'similar(CDS( features,'but'are'frequently'not'configured' the'same'way' CDS'triggered'in'one'segng'may'not'be'confirmed' or'rerenacted'in'subsequent'segngs' Without'con9nuity'and'consistency'across' segngs'and'ins9tu9ons,'interven9ons'have' decreased(effec%veness(for'dissemina9ng' evidence'and'reducing'unwarranted'variability'
23 Knowledge'Exchange'is'vital' CDS?( Home( CDS?( Rehabilita%on( Phase( Shared( Repository?( Integrated( KM(Programs?( Ambulatory( Visit( CDS?( Hospital( Procedure( CDS?(
24 CDS'overview' CDS'known'to'improve(care( BeQer'with'more'complex(CDS' But'has'to'follow(the'pa9ent' US'EHR'incen%ves(require'CDS'use' Dependency'on'available'structured'data' High'data(quality(and'consistency(is'a'essen9al' Alignment'with'quality'&'safety'measures'' Knowledge'is'constantly'growing( Exis9ng'knowledge'assets'quickly'obsolete' Must'evolve'toward'individualized(decisions( Must'combine'evidence(&'personal(preferences(
25 Successful'KM'Program' Enables'health'care'ins9tu9ons'to'effec9vely' u9lize'knowledgetdriven(computer'systems' Improve'care'safety'and'quality' Keep'pace'with'frequent'scien9fic'advances' Embrace'new'care'delivery'models' Promote'con9nuous'learning' Overcome'knowledge(engineering(and' implementa%on(challenges'
26 Acknowledgements( Saverio'Maviglia' Margarita'Sordo' Beatriz'Rocha' Eileen'Yoshida' Charles'Lagor' Priyaranjan'(Raj)'Tokachichu' Christopher'Vitale' Dan'Bogaty' Other'members'of'the'Clinical(Informa%cs(Team(at'Partners'
27 Thank(you!( Roberto A. Rocha, MD, PhD This'work'by'Roberto'A.'Rocha'is'licensed'under'a'Crea9ve'Commons'AQribu9onR NonCommercialRShareAlike'4.0'Interna9onal'License'
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