BC Digital Health Demo Days | Keynote By Daniel Schwartz, QxMD

Enhancing Decision Making at the Point of CareDaniel Schwartz, MDQxMDMarch 29, 2012

Becoming an MD…

1 in 10 patients is actually harmed while receiving hospital care

What is wrong with me?

What will happen to me?

What is the best treatment for me?

Providing Better Answers

Diagnosis

Prognosis

Therapeutics

Taking Breathing For Granted…

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Taking Breathing For Granted…

Savings Lives by Moving a Dial

High lung volumes | Mortality 40%

Low lung volumes | Mortality 31%

EvidenceNecessary but not sufficient

Knowledge Translation

Current Practice Improved Patient Outcomes

Evidence

Prognosis | What will happen to me?

Kidney Failure Risk Equation

Therapeutics | Best treatment?

Membranous Nephropathy

Watchful waiting

Or

Intensive chemotherapy?

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.

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%.

Kids Are Not Small Adults

Computer Aided Cancer Detection

Computerized assistance improves cancer detection

MDs failed to recognize missed cancer in 70% of cases where computer was right

Nishikawa et el.  Clinically Missed Cancer: How Effectively Can Radiologists Use Computer-Aided Detection? AJR March 2012 vol. 198 no. 3 708-716 doi:10.2214/AJR.11.6423

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 doi: 10.1136/bmj.38398.500764.8F

Going to Medical School

Airstrip

Tech

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Better outcomes from better evidencePoint of Care Delivery