Knowledge Translation and Care Pathway Optimization Using Mobile and Web-based Tools
The rise of smartphones, tablets and web apps have provided opportunities to enhance evidence-based practice. RenalConnect ensures adherence to care pathways for patients with end stage renal disease, while providing robust, real-time analytics that can be used to evaluate CQI activities. Mobile apps such as Calculate by QxMD and Read: Personalized Medical Journal encourage engagement with & application of current research and best practices. These applications will be discussed as a means to facilitate knowledge translation at the point of care.
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BCATPR 2013 | RenalConnect & Read by QxMD
1. Knowledge Translation & Care
Pathway Optimization Using
Mobile and Web Based Tools
Daniel Schwartz, MD
June 18, 2013
2. 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
3. 1 in 10 patients is actually
harmed while receiving hospital
care
13. 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
14. 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
15. 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?
17. 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
18. 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
19.
20. 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.
29. 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
30. 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%.
35. 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
40. 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
41. Protocolized care
Patient presents
with peritonitis
Start antibiotics
empirically, send PD
fluid swabs for
culture & sensitivity
Follow-up culture
results, then modify
treatment
Repeat culture at end
of
antimicrobial
treatment to
confirm clearance
Organize home visit,
patient education to
increase chance of
peritonitis-free PD
Continue ongoing
regular follow-up
60. 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
61. 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
The rise of smartphones, tablets and web apps have provided opportunities to enhance evidence-based practice. RenalConnect ensures adherence to care pathways for patients with end stage renal disease, while providing robust, real-time analytics that can be used to evaluate CQI activities. Mobile apps such as Calculate by QxMD (qx.md/calculate) and Read: Personalized Medical Journal (qx.md/read) encourage engagement with & application of current research and best practices. These applications will be discussed as a means to facilitate knowledge translation at the point of care.
