Personalising Evidence Clinical Evidence interactive A Learning Exercise

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Personalising Evidence - Clinical Evidence
interactiveA Learning Exercise

• Andrea Lane
• BMJ Publishing Group
• London, UK
  

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Goals

• To improve the quality of healthcare by
  providing
• A range of treatment options tailored to
  individual patients and their illnesses
• Arguments for and against each treatment option
  to empower patients and healthcare professionals
  to weigh up and make informed choices

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What is Clinical Evidence interactive?

• A joint project between BMJ Knowledge and
  InferMed Ltd, a technology company (partly owned
  by Cancer Research UK) specialising in decision
  support technology.
• Resulting in a teaching tool that will allow an
  end-user to obtain evidence-based information
  that is personalized.
• It integrates the high quality evidence-based
  content of CE with the Arezzo preference engine
  (created by InferMed) resulting in a personalized
  evidence-based set of options.

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What does this mean?

• Using CE-i, a doctor could enter information
  about a particular patient and find out what the
  evidence says is the most appropriate next step
• A patient could interpret the evidence as it
  impacts on them.

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For Example

• the options for a black man with heart failure
  who was already taking a loop diuretic and an ACE
  inhibitor and was New York Heart Association
  Class III would be different than those for a
  caucasian man on no medication who was NYHA Class
  I.

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Benefits

• Instant access to the latest evidence, analysed
  and compiled to the quality assured standards of
  BMJ Publishing
• Evidence is customised to individuals rather then
  populations, which decreases effort in finding
  relevant information and supports
  physician/patient decision-making
• It can support clinical governance, audit and
  Continuing Medical Education

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CEi utilises

• Information about treatment options, benefits and
  harms
• Clinical Evidence (based on evidence)
• Best Treatments (options where evidence is
  lacking)
• Information about the individual patient
• Electronic Patient Record (EPR)
• Online questions about clinical information which
  is then saved into the EPR
• Ability to link treatment options to the
  individual patient
• AREZZO (decision support technology)

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Additional ideas

• Dynamic linkage to decision support enabled
  version of BNF
• AREZZO can create a complete record of patient
  information and decisions taken by the user
  (patient state)
• Patients state can be reloaded at any time in
  the future to continue the guideline (for example
  if an intervention doesnt work)
• Can analyse multiple patient states to review the
  effectiveness of the guideline in practice
• Feedback from the analysis can help improve the
  guideline

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Market Feedback

• Individual and group usability interviews have
  been held with over 60 General Practitioners and
  Nurse Practitioners to date
• Feedback to date has been extremely positive,
  including individuals who admit to being slow to
  adopt innovation
• Recommendations about style, output etc. are
  being incorporated into current prototypes