Just-in-time Decision-

Support for Improving and

Optimising Professional

Practices

Prof. Antoine Geissbühler, MD

Geneva University Hospitals

1999: to err is human

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al., P

edia

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00

5;1

16:1

50

6-1

512

2005: e-iatrogenesis

Meaningful integration in the care

processes

Geneva University Hospitals

• 2'200 beds

• 3 campuses, 30 smaller sites

• Primary, secondary and

tertiary care

• 50'000 admissions/year

• 800'000 outpatient visits/year

• 10'000 collaborators

• 1‘500 physicians

• 3'500 nurses

Considering today'sserum creatinine level, I recommend that youadjust the dosage of intravenous gentamicinto 80mg every 24 hours(and check its bloodlevel in three days)

Supporting care production

• Electronic health record

• CPOE and clinical decision-support tools

• Collaborative care pathways

• Health information exchanges & telemedicine

Learning from care

data• Information collection, aggregation

• Knowledge discovery

• Population-level surveillance

Activating new

knowledge

• Knowledge validation and operationalization

• Clinical decision-support tools

• Patient simulators

decisions,

actions

data,

signals

information,

knowledge

integration,

interpretation

A "learning institution"

just in time

at the point

of care

decisions,

actions

Patient record

- visualisation

- data capture

- links to KB

Provider

order entry,

decision

supportCare planning

and

documentation

Institutional

knowledge

management:

- creation

- validation

- distribution

Knowledge

discovery,

data mining

Alerts and

notifications

data,

signals

information,

knowledge

integration,

interpretation

Scheduling and

optimization

A "learning institution"

just in time

at the point

of care

Integrating information

From documentation to coordination

Collaborative care: clinical pathways

Connecting with the real world

Driving decisions with clinical data

Discovering knowledge: @neurIST

DEBUG-IT