This is the presentation given to the HL7 Clinical Interoperability Council on Clinical Decision Suppoprt (referenced in the post below), April, 2009.

1. Clinical Decision Support Blackford Middleton, MD, MPH, MSc, FACP, FACMI, FHIMSS Chairman, Center for Information Technology Leadership Corporate Director, Clinical Informatics Research & Development Partners Healthcare System Harvard Medical School Bridging the Chasm HL-7 Clinical Interoperability Council April 19-21, 2009

16. Rates of Positive Survey Responses on the Effect of Adoption of EMRs, 2008 DesRoches CM et al. N Engl J Med 2008;359:50-60` 4% of physicians use fully functional electronic health records 13% use some form of basic electronic records Middleton B Health Aff 2005;24(5):1269-72 Yet, 89% of the benefit of HIT goes to others,

21. CAD/DM Smart Form Medication Orders Lab Orders Referrals Handouts/Education

22. Converting evidence to care Publication Bibliographic databases Submission Reviews, guidelines, textbook Negative results variable 0.3 year 6. 0 - 13.0 years 50% 46% 18% 35% 0.6 year 0.5 year 9.3 years Dickersin, 1987 Koren, 1989 Balas, 1995 Poynard, 1985 Kumar, 1992 Kumar, 1992 Poyer, 1982 Antman, 1992 Negative results Lack of numbers Expert opinion Inconsistent indexing 17:14 Original research Acceptance Patient Care 17 years to apply 14% of research knowledge to patient care! Balas Yearbook Medical Informatics 2000gtre4, courtesy M Overhage

23. Partners Knowledge Management Portal The Knowledge Management Portal Filter-Based Search page: This screen shot illustrates the filter search selections that facilitate knowledge –sharing across Partners HealthCare System. Filter selections include: Clinical disciplines, entity, venue, application, content type, disease management and patient safety.

26. Knowledge Artifacts by Layer Published Guideline Semi-structured Recommendation Abstract Rule Abstract Order Set Executable Rules Order Sets in CPOE system

27. Discussion, Q&A Blackford Middleton, MD, MPH, MSc [email_address]