Delivering Knowledge into the WorkflowJonathan Teich – AMDIS fall symposium, Sept. 30, 2013

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The Guy Who Knows

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New Condition = angina FAQs

How do Iconfirm Dx?

Gen info about angina

What are thetreatments?

What can Iexpect? (clin

course/hazards

Info about relevant MEDS

Info about relevant procedures

Disposition, re:admission criteria

NitroglycerinBeta blockers

Antiplatelet agentsHeparin

Cardiac cathPTCA (stents)

Angina OrderSet:

Meds, O2, Monitoring, x-ray,

labs

1. Order Clopidogrel FAQs

ALERT: Don’t use in

Patients takingWarfarinCheck rules

Info aboutmed

2. Procedureneeded

Procedureadvice

Information needs

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Clinical Decision Support

• CDS = “Providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care.”

• Stuff you learned once from books and journals, reformatted and delivered when and how you need them in practice

– Tailored to the current situation– Delivered for best action

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Like a GPS, CDS supplies information tailored to the current

situation, and organized for maximum value.

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Goal

We seek to repurpose the content available in books, journals, guidelines, etc.,

to deliver the most precise information and the most useful form

For any given workflow and information need

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Physician information needs and queries

• Data about hundreds of thousands of queries to MDConsult, First Consult

• Synthesized ontology of information needs

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Smart Content – turning content into action

1. Content• Curated,

maintained

2. Content indexed as discrete, reusable

facts

3. Content tailored to the situation• Matched to

insertion points, patient data, information need configuration

4. Actionable tools• External,

service-based• Integrated into

EHR screens

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Patient-specific workup options: diagnostic and therapeutic

choices

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Summary

• Knowledge is a parallel to data – they both have ontologies, coding, and could have standards

• Knowledge can be applied in different forms for different workflows and different users

• Need to balance working with EHRs, SMART sidecars, standalone references, smartphones – for the best clinical result

j.teich@elsevier.com

jteich@harvard.edu