PRODIGY

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PRODIGY

• eHealth Workshop May 2004
• Clinical decision support systems
• Dr Sharon Smart

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Information paradox

• Estimated 5 million medical facts
• In one year 10,000 RCTs published (1995)
• 17,000 drugs on the market with dozens of new
  drugs available each year
• Over 1000 guidelines available through the NGC

we are increasingly overwhelmed by information
that is neither readily accessable when it is
needed, or easy to use it is unmanageable and
does little to aid decision making
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What is PRODIGY?

• PRODIGY is a source of clinical knowledge that
  can support healthcare professionals manage the
  common conditions seen in primary care.
• Designed to be used
• During the consultation to aid decision making
• As a learning resource for health professionals
• To support the sharing of decision-making and
  information with patients

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How can you use PRODIGY now?

• Knowledge can be accessed by using
• Release 1 decision support system
• Website www.prodigy.nhs.uk
• Book
• Complimented by
• A computer-based educational package that
  supports the use of computers in the consulting
  room
• A video and DVD

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How can PRODIGY support decision making during
the consultation ?

• Outline of the management options
• Prescribing of recommended drugs
• Explanation why drugs are or are not recommended
• Referral advice
• Advice on appropriate investigations
• Follow up advice
• Shared screens
• Patient information leaflets

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What sort of background information does PRODIGY
guidance offer as a learning resource?

• Aims of treatment
• Outcome measures relevant to primary care
• Definition of the condition and outline of the
  pathophysiology
• Description of the epidemiology
• Diagnostic and investigational issues
• Differential diagnosis
• Complications and prognosis
• Management issues
• Full list of references

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Can I trust the information?
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Allocate topic to Authoring Trio
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Implementation into Release 2 system
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PRODIGY in GP clinical systems

• RFA 99 specifies the clinical system should
  support the use of PRODIGY
• Software requirements specification basis for
  development and implementation of the software
  for the delivery of the PRODIGY knowledge
• User-interface for Release 1 has not been
  developed by SCHIN and is different on each
  system
• PRODIGY knowledge developed and maintained at
  SCHIN and suppliers issued with regular up-dates

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PRODIGY Browser

• Simulates the version of PRODIGY currently
  available in primary care clinical systems
• www.prodigy.nhs.uk

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PRODIGY

• Release 2
• The new version of the decision support system
  currently (not yet implemented)

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PRODIGY Release 2

• Uses the clinical knowledge in different ways to
  suit the needs of different clinicians
• Alerts, prompts and reminders
• Condition pathways
• Learning resource

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PRODIGY Release 2

• Covers all aspects of disease management in
  primary care prescribing investigations
  referrals patient advice shared
  clinician/patient decision making
• Makes intelligent use of information available in
  the electronic record (past history, severity of
  the condition, co-morbidity, and past and current
  medication) before recommending options for
  management
• Ranks these options or choices in order of
  preference
• Records all decisions and actions in the medical
  record
• Facilitates data collection intelligently

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PRODIGY Release 2

• Demonstration

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PRODIGY information panel links to useful
resources e.g. condition pathways, patient
information leaflets
PRODIGY pop up boxes offer alerts, prompts,
reminders to support safe and high quality
practice (and the GMS contract)
Patient who had an MI in January 2004 is brought
up in the clinical system
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You decide to record that an ETT has been carried
out
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and it appears immediately in the medical record
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Right click on the icon to customise the display
of pop up boxes
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Browse the patient information leaflets
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Print the PIL
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Select a condition pathway
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.provides supporting information
The system presents the most likely situation
from information in the clinical record
.displays summary information from the patient
record that is relevant to the condition
.allows quick and easy data entry
.displays the management choices that are made
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Add some more recent data
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The summary information is immediately updated
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as is the medical record
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Click once on the text for information
Click twice to select
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Then make an assessment..select tolerating
treatment
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Hover and an explanation will be displayed
Management options are displayedthese are
preferenced
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Highlight the text for more information in this
box
Select your choice of management.
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Select simvastatin
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Now manage the patients antiplatelet therapy by
selecting this tab
Actions you have selected are displayed in the
task box
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The medication record suggests this is the
current situation select if correct
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The system indicates something you had initially
overlooked
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This contraindication to aspirin is in the record
- but hidden
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Select clopidogrel
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Check the selected actions and click finish
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.. and these are written back to the record
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The cost of knowledge management is high..

• but that of ignorance is higher

David Smith, Unilever, Ignorance Adds Excitement
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