Wednesday, September 01, 2010

This Is Pretty Exciting News - I Wonder Will Australian Users Get Access At Some Point?

The following blog post appeared a few days ago.

Tuesday, August 24, 2010

Evidence-Based Medicine’s Giant Leap

Cerner and the British Medical Journal (BMJ) have teamed to provide evidence-based medicine (EBM) embedded in the electronic medical record in a manner that is as exciting and encouraging a development in healthcare IT as anything I’ve ever seen — I repeat, as exciting as anything I’ve ever seen. Coming from a noted cynic and critic of healthcare IT, this flash of optimism is a significant change in the wind.

I was attracted to healthcare by the huge greenfield opportunity to apply the lessons I learned in military command centers (the Universe loves irony) about embedded computerized decision support. I’ve been searching for a sustainable piece of grass in that green field ever since.

One of the factoids I enjoy throwing around is the length of time that elapsed before US healthcare providers widely adopted and routinely practiced EBM for the treatment of community-acquired pneumonia —17 years. The Mean Time To Improvement (MTTI) in healthcare is abysmal, but not because clinicians are unwilling to change, rather because the clinicians don’t always know how to change or whether they should change at all.

The BMJ methodology provides clinicians with a trustworthy and convincing source of evidence upon which to justify a change in clinical behavior; and the integration of the BMJ knowledge into Cerner’s EMR gives clinicians an easy avenue for practicing that change in a fashion that can drive the MTTI in healthcare from decades to days. That’s not a dramatic overstatement — this collaborative effort between Cerner and BMJ, and what I hope will be similar efforts in the future, can radically lower the MTTI in healthcare.

As I mentioned in previous blogs, one of my major challenges in this relatively new position as CIO is to squeeze more value — measurable and perceived — from the Cayman Islands’ substantial investment in Cerner’s products. At the same time, we are undertaking a new care delivery model here that looks and feels very similar to the concepts evolving in the United States under an Accountable Care Organization (ACO) and Medical Home.

Among other commitments, our new model (known as CayHealth) is contractually committed to practice and measure EBM. The challenge, of course, is to enable EBM, that is, make it as easy as possible for clinicians to practice true EBM and then measure that practice somehow. This marriage of BMJ’s EBM content with Cerner’s Millennium application suite is an opportunity to do both — derive more value from the Cayman Islands’ Cerner investment, as well as support the imperatives of CayHealth.

Historically, there have been several barriers that were too high for EBM to hurdle:

· Governing the definition and content of EBM

· Updating, maintaining, and disseminating EBM to clinicians in a timely fashion

· Efficiently integrating EBM into the clinicians’ workflow

· Achieving all the above while making EBM affordable

The Cerner-BMJ collaboration knocks every one of these hurdles to the ground.

Read the details here:

The blog is written by Dale Sanders, CIO of the Cayman Islands National Health System.

For those who are curious go here:

It seems there are only 60,000 or so people living there but that it has a huge economy, built apparently on being a rather major tax haven!

A little more research came up with this site:

BMJ Evidence Centre

Action Sets and Cerner Millennium

We have worked closely with Cerner to develop our Action Sets within the CareDesigner tool, which effortlessly pre-validates them for integration directly into the Millennium PowerChart.

Customised for your specific needs

Cerner Millennium’s PowerChart centralises patient information management and supports comprehensive care planning and coordination. Care plans and orders are created specifically for each region, and reviewed by local expert reviewers. They can be individualised based on the patient information entered during admission and ongoing treatment.

Giving you control

Cerner’s Care Designer tool enables customers to customise Action Sets for use within their organisation, for example, by incorporating national, regional or local guidelines. You can change, add to or remove Action Sets in line with changing guidelines and local best practice. Local Cerner teams work closely with all customers to support successful implementation.

The Action Sets package includes links to Evidence Summaries, which present relevant content from Best Practice, Clinical Evidence, performance measures, and links to Cochrane and national and international guidelines. The package also includes full web access to Clinical Evidence and Best Practice allowing for both to be used as referential tools outside of the clinical workflow.

----- End Page.

Pleasingly it seems the core information is available in standardised form for integration into a range of clinical systems.

See here:

Systems integration

There is considerable diversity in the electronic health systems being used by hospitals, and no single solution for integrated healthcare.

Accordingly, the BMJ Evidence Centre supports multiple delivery channels for its authoritative healthcare information. We store our content in an industry-standard structured format and can provide access to it via a web API. This enables clinicians to access our authoritative evidence, expert opinion and guidelines within the tools they already use.

Our approach is to develop support for whatever standards, contexts and vocabularies your system requires. We already support the following for structuring and querying our clinical information:

  • HL7 Infobutton, REST, or other messaging standards (e.g SOAP)
  • Multiple query contexts covering treatment and diagnosis
  • Clinical vocabularies including ICD 9 / 10, SNOMED-CT and free text
  • Results in a range of formats including XHTML, XML, ASCII, Atom/RSS

----- End Extract.

Maybe NEHTA or DoHA could investigate and possibly fund some form of national program to have this information made available to Australian practitioners.

Dream on I guess!


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