Knowledge Translation & Care Pathway Optimization Using Mobile and Web Based ToolsDaniel Schwartz, MDJune 18, 2013

Objectives

Learn about the impact of a web-based patient management tool that helps health care professionals adhere to best practices while collecting useful administrative & CQI data

Become familiar with the impact of mobile apps for smartphones and tablets that can be utilized to access decision support tools and personalized reference materials at the point of care

1 in 10 patients is actually harmed while receiving hospital care

What is wrong with me?

What will happen to me?

What is the best treatment for me?

Providing Better Answers

Diagnosis

Prognosis

Therapeutics

Taking Breathing For Granted…

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Taking Breathing For Granted…

Full text: http://qxmd.com/r/10793162

Savings Lives by Moving a Dial

High lung volumes | Mortality 40%

Low lung volumes | Mortality 31%

http://qxmd.com/r/16304249

Medical literature is constantly being published

Landmark clinical research, if adopted and put into practice by healthcare practitioners, has the capacity to save lives

Medical Literature as a Source of Knowledge

HCPs may not stay up-to-date with landmark clinical research

It often takes years for the latest best-practices to be integrated into a physician’s practice

The Problem

Barrier to Discovery 1,000s of Medical Journals; each journal publishes

hundreds or thousands of papers/year Difficult to separate the wheat from the chaff

Barrier to Access Content hidden behind paywalls University and hospital site licenses still require extensive

effort to navigate

Why?

Think PubMed meets Flipboard

Solution:‘Read by QxMD’

Personalized Medical Journal

Use combination of crowdsourcing, data feeds, aggregated behaviour analysis to display content important to the user

Navigate institutional access and site-licenses seamlessly

http://qx.md/read

Read by QxMD

Traditional Access Method Using ‘Read by QxMD’

• Search for paper of interest

• Click to view• Paper behind paywall?

• Navigate to institution for institutional access

• Login• Search for paper• Find and select paper in

search results

• Estimated Time: ~ 5 min

• Discover paper of interest• Tap to view• Heal the sick

• Estimated Time: < 20 seconds

Comparison

Accessing a Paper

Save >100K lives per year just by doing what we already know we’re supposed to do1

Impact

1To Err Is Human: Building a Safer Health System. Kohn L, Corrigan J, Donaldson M, eds. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press; 1999. ISBN: 9780309068376.

Read

Demo

EvidenceNecessary but not sufficient

Knowledge Translation

Current Practice Improved Patient Outcomes

Evidence

Full text: http://qxmd.com/r/21482743

Prognosis | What will happen to me?

Kidney Failure Risk Equation

Therapeutics | Best treatment?

Membranous Nephropathy

Watchful waiting

Or

Medical therapy

Simple Tools Make Big Differences

“Testing for pulmonary embolism often differs from that recommended by evidence-based guidelines.”

Durieux et al. A computerized handheld decision-support system to improve pulmonary embolism diagnosis: a randomized trial. Ann Intern Med. 2009 Nov 17;151(10):677-86.

Full text: http://qxmd.com/r/19920268

Checklists

A simple safety checklist (the Surgical Safety Checklist) in the operating room can significantly reduce post-operative complications.

Specifically, death after surgery was reduced by more than 40%.

Kids Are Not Small Adults

Impact of Clinical Decision Support

Decision support systems can improve clinical practice

But, up to 30% of systems don’t have any meaningful impact

Kawamoto et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330

http://qxmd.com/r/15767266

Web Apps in Renal Care

Peritonitis

Intra-abdominal infection

Achille’s heel of home dialysis

Peritonitis

Peritonitis Tracking & Management Solution Tracking = Data Management = Clinical Decision Support

Technical aspects

Web-based application hosted in the cloud (“cloud computing”)

Written in Perl, HTML, JavaScript, and CSS >10,000 lines of code

MySQL database for data storage

Open source – on Github github.com/renalconnect/RenalConnect

Protocolized care

Patient presentswith peritonitis

Start antibioticsempirically, send PDfluid ± swabs forculture & sensitivity

Follow-up cultureresults, then modifytreatment

Repeat culture at end ofantimicrobial treatment toconfirm clearance

Organize home visit,patient education toincrease chance ofperitonitis-free PD

Continue ongoingregular follow-up

Accessing the service

Alerts

BEFORE

AFTER

Accomplishments | Peritonitis Rate

2008 1:20

months

2009 1 :21.5

months

2010 1:26.6 month

s

2011 1:30.6 month

s

2012 1:34

months

What’s coming?

Going to Medical School

Airstrip

Tech

nolo

gie

s

Google Glass

Heads Up Display

Demo Video

http://youtu.be/9c6W4CCU9M4

Google Glass in Healthcare

Anatomical landmarking during procedures Assistance with access canulation

Listen in to the conversation Semantic analysis of speech Auto-suggest differential diagnosis, phone numbers, drug

dosing

View patient results at the point of care

Rounding in the HD unit

Past medical history

Acute issues to follow up (eg investigations, referrals, BP/goal weight, etc)

Pending appointments

Chronic issues Transplant status (referred? If no, why?) Access (line? If so, why?) Code status (what is it? Documenting ‘Full Code’?) Plans for home dialysis? “Right Start” action items

Better outcomes from the application of better evidencePoint of Care Delivery

Acknowledgements

Mobile Apps (Calculate, Read)

Chan Kruse

Michael Verde

Stephane Boyer

Dimas Yusuf

PTMS (Renal Connect)

Dimas Yusuf