Clinical

Cli i lP Protocols
t l and
dPPathways:
th
g g into HIMS
integrating

Milliman India
Aug 05, 2010

1 August 18, 2010

Agenda
ƒ Evidence based medicine

ƒ Evidence based medicine tools

ƒ Leveraging clinical logic for HIMS

2 August 18, 2010

Evidence based medicine
What is EBM: "the conscientious, explicit and judicious use of
current best evidence in making decisions about the care of the
individual patient”
patient (Sacket et al 1996)

Th evidence
The id f using
for i evidence:
id In 1998, Dr. David Sackett,
using an "evidence cart" on rounds, reported that of 71 information
searches to answer clinical questions, 37 (52%) confirmed the
management decision,
decision but 18 (25%) lead to a new therapy or
diagnostic test and 16 (23%) corrected a previous plan.

(Sackett D,
D 1998)
“25% lead to a new
therapy or diagnostic test
and 23% corrected a
previous plan”

3 August 18, 2010

Criteria for successful evidence based medicine
ƒ Content must provide a clinical rationale for decision making.

ƒ Must help determine the appropriateness of a proposed medical

intervention.

ƒ Provide guidance across the continuum of care based on best-

demonstrated practice.

ƒ Be useable with concise, actionable, and measurable items.

Success = Alignment of treatment with evidence

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 Development Process
Multiple research publications
Search ƒ Clinical papers, Journals
ƒ Text books

Create evidence repository and review

Create strength of collated evidence

Critical appraisal
Validate ƒ Peer review
ƒ Expert consultation

Extract and merge evidence from

Extract multiple sources to identify global best
practices

Link best practice model to best

Link practice patient care through the use
off tools
l

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Agenda
ƒ Evidence based medicine

ƒ Evidence based medicine tools

ƒ Leveraging clinical logic for HIMS

6 August 18, 2010

 Evidence based medicine tools
Based on extensive research of the best Indian and
international evidences:

– Clinical protocols

– Clinical pathways

– Patient care flowcharts

– IT Integration into HIMS/ EMR

August
7 18, 2010
The e-volution

Flowcharts Protocols Pathways IT Integration

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Patient Care Flowcharts
Flow of events that would occur in the patient care path.

– Concise description
– Quick reference guide
g

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Clinical Protocols
Evidence based recommendations that guide the clinical
teams with evidence backed indications / standards to take
best clinical decisions at various stages of patient care

– Best practice clinical recommendations

– Each recommendation is referenced and linked to the
research evidence

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Clinical Pathways
Investigations and instructions in most logical sequence of
patient care

– Indications and criteria to support clinical decisions

– Based on the current best practices

– Designed as easy to use medical documentation tool

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Agenda
ƒ Evidence based medicine

ƒ Evidence based medicine tools

ƒ Leveraging clinical logic for HIMS

18 August 18, 2010

Challenges & solutions for integrating clinical logic

ƒ Traditional IT developer – physician divide, no common language

ƒ Clinical team to provide content in a “easy to understand” and easy to
integrate format
ƒ How much is enough, going overboard vs keeping it too simple
ƒ Be clear about your expectations
expectations, are you providing evidence at point
of care as reference or are you creating a decision support system
ƒ No blackbox, evidence has to be linked for easy reference
ƒ License
Li the
th relevant
l t evidence,
id provide
id access through
th h user iinterface
t f
ƒ Regular updates needed, dedicated clinical team to refresh content
ƒ Have a strategy for updating content

19 August 18, 2010

 Rules

Logic
`

Knowledge

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Integrating
g g clinical logic:
g sample
p format

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 Mapped References

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 Mapped References

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 Alerts!

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 Alerts!

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 Evidence reference

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 Validation Check!

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 Validation Check!

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 Bringing Evidence Based Medicine to where

it matters the most

at the point of care.

For more information please visit us at Stall No 51

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