100% adherence to guidelines an expert system for preoperative screening
TRANSCRIPT
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100% Adherence to GuidelinesAn Expert System for Preoperative Screening
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Anesthesia?
• Before the invention of anesthesia surgeons had to be strong and quick
• Conscious patients endured excruciating pain
• Alcohol, opium or other botanicals sometimes helped
• Many patients died during surgery
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Anesthesiologist?
• Doctor that keeps the patient alive during surgery
• Uses evidence based medicine (guidelines) to reduce risks
• Risk of death from general anesthesia alone is 0,01-0,016% (Lienhart 2006, Arbous 2001)
• Risk increases with morbidity and the extent of surgery
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Preoperative Screening?
• Prior to every surgical procedure under anesthesia
• 15000 screenings per year• Screening:– Identify and optimize relevant medical
conditions– Estimate and reduce perioperative risks– Inform the patiënt
• 10 minutes per screening• Needs to be thorough, efficient and smart
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Epic® Anesthesia?
• Module of the Epic® EMR• Configurable by end users• Free sharing of build within the worldwide
usergroup• Epic® UserWeb as a vehicle to share ideas
and solutions• With smart configuration we created the
expert system that won the Spider Award
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Problem Definition
• Numerous extensive guidelines
• The relevant clinical rules are in there somewhere
• No time for reading during preoperative screening
• Results in poor adherence to guidelines
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Objectives for Configuration
• Lean screening• Automated text
generation• 100% adherence to
guidelines• Uniform high standard
of care• Elimination of
medication errors• Quality of care
reporting• Research readiness
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Configuration: First Step
• Create flow charts from guidelines
• Crossroads are rules• Combinations of rules
are criteria• Treatment is warrented
when criteria are met
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Configuration: Second Step
• Create OrderSets for each treatment• Preconfigure each order to eliminate
medication errors or omission• All orders are ready to sign for the end
user
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Configuration: Third Step
• Create Best Practice Alerts• Triggered by criteria• Presents the evidence based OrderSet for
the required treatment
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Configuration: Fourth Step
• Incorporate the rules in the preoperative screening form
• Use scripting to show follow-up questions only when needed
• Add other smart stuff
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Configuration: Fifth Step
• Document everything automatically• Organize the information logically• Be specific and to the point
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Live Demonstration