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Clinical Decision Support at Partners Healthcare (Text Version)

Slide presentation from the AHRQ 2009 conference

On September 14, 2009, Blackford Middleton, MD, MPH, MSc made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (3741 KB).

Slide 1

Clinical Decision Support at Partners Healthcare

Blackford Middleton, MD, MPH, MSc
Corporate Director, Clinical Informatics R&D
Chairman, Center for IT Leadership
Partners Healthcare System
Harvard Medical School
Harvard School of Public Health


Slide 2

Overview: CDS Dimensions

  • Provider workflow
    • Lookup
    • Alert
    • Interrupt
    • Actionable
    • Documentation-centric
    • Population (Cohort)
  • Patient Relevance
    • Non-specific
    • Specific/tailored
  • Consumer
    • Lookup
    • Alert
    • Population (Cohort)
  • Methods
    • Inference methods (rules, etc.)
    • Temporal reasoning (protocols/pathways)
    • Values/Utilities (preferences: pt/provider)

5*2*3*3 = a minimum of 90 different approaches to CDS!


Slide 3

Partners CDS

  • CPOE
  • Alerts & Reminders
  • Actionable CDS
  • Documentation-centric CDS
  • Population/cohort
  • Patient-directed CDS


Slide 4

Medication ordering -- main screen


Slide 5

KnowledgeLink in the Workflow


Slide 6

Secure Messaging
Task Management
Clinical Alerts
Patient Lists


Slide 7

CAD/DM Smart Form

Smart View: Data Display
Smart Assessment, Orders, and Plan
Assessment and recommendations generated from rules engine
Smart Documentation
Anti-platelet therapy
Blood pressure
Glucose control
Eye and foot examinations


Slide 8

CAD/DM Smart Form

Medication Orders
Lab Orders


Slide 9

CAD Quality Dashboard

Targets are 90th percentile for HEDIS or for Partners providers
Zero defect care:
Blood pressure
Red, yellow, and green indicators show adherence with targets


Slide 10



Slide 11

Serious Medication Error
Rates Before and After CPOE

Bates et. al. JAMA 1998.


Slide 12

Preliminary Results: Smart Form On Treatment Analysis


Slide 13

Patient Journal Causes
Provider Activation

Grant RW et al. Practice-linked Online Personal Health Records for Type 2 Diabetes: A Randomized Controlled Trial. Arch Intern Med. 2008 Sep 8;168(16):1776-82. .
More medication changes in visits after diabetes journal submission:


Slide 14

An external repository of clinical content with web-based viewer

Search Criteria
Content Type...


Slide 15

'Crowdsourcing' Knowledge Engineering

Personal Health
Information Network
Community ("Crowd")
Medical Professional
Rule builder
Rule engine
Clin. Inf. System
Petter K. Risøe
HSPH HPM512 2009


Slide 16

Where are we?

"I conclude that though the individual physician is not perfectible, the system of care is, and that the computer will play a major part in the perfection of
future care systems."

Clem McDonald, MD NEJM 1976

Thank you!
Blackford Middleton, MD

Current as of December 2009
Internet Citation: Clinical Decision Support at Partners Healthcare (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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