Clinical Decision Support at Partners Healthcare (Text Version)
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).
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
Overview: CDS Dimensions
5*2*3*3 = a minimum of 90 different approaches to CDS!
- Alerts & Reminders
- Actionable CDS
- Documentation-centric CDS
- Patient-directed CDS
Medication ordering -- main screen
KnowledgeLink in the Workflow
CAD/DM Smart Form
Smart View: Data Display
Smart Assessment, Orders, and Plan
Assessment and recommendations generated from rules engine
Eye and foot examinations
CAD/DM Smart Form
CAD Quality Dashboard
Targets are 90th percentile for HEDIS or for Partners providers
Zero defect care:
Red, yellow, and green indicators show adherence with targets
Serious Medication Error
Rates Before and After CPOE
Bates et. al. JAMA 1998.
Preliminary Results: Smart Form On Treatment Analysis
Patient Journal Causes
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:
An external repository of clinical content with web-based viewer
'Crowdsourcing' Knowledge Engineering
Clin. Inf. System
Petter K. Risøe
HSPH HPM512 2009
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
Blackford Middleton, MD