Press Conference

Presentation of the Clinical Knowledge Portal

Nowadays, clinical cooperation is essential for facing the complex challenges due to the ageing population, pollution and migrations flows.
However, achieving clinical cooperation between actors that use different tools, e.g. EMRs, is still very difficult, if not impossible, at the moment. Without proper tools helping doctors to share clinical information originating from several different sources, the clinical risk increases and economic resources get wasted.

First step

The clinical data sharing

Doctors, even those working in the same structure, have today major difficulties in sharing clinical information for treating a patient.
Normally, they use different EMR systems, set for encoding and recording clinical data using different approaches (e.g. SNOMED, LOINC, etc.) and different definitions of the same clinical concepts. In some cases, systems have been interconnected through interoperability mechanisms, which permit to transfer data from a system to another.
While this is certainly a good result for a general utilization, it turns out to be totally inadequate for ensuring the clinical cooperation. For example, if we need to share a patient’s body temperature, just expressing its value is not enough: for clinical purposes, the simple “value” of the temperature is not a precise clinical information; in order for it to have a clinical sense, we also need to know where it has been measured, through which device and so on.
Providing all the involved clinicians with the same EMR and asking them to use a unified encoding approach may seem a possible solution, but in our reality this is neither realistic nor achievable. Rightly, doctors don’t want to change their current EMR or the way the encode clinical information; the costs of this kind of project (both direct and for managing the change) would be far too high.

Not just communication but...

Guidelines to improve healthcare

The CKP enables the full sharing of the clinical best practices and guidelines thanks to the management of clinical use cases. A clinical use case is the intersection point between 7 different factors: symptom, disease, comorbidity, stage of disease, clinician involved, context in which he works, time.
For example, a clinical use case is when a patient complains of chest pain, which could be symptom of an acute myocardial infarction, he has diabetes and I am an emergency doctor making a first evaluation in the ambulance. In this CuC I have specific information exigencies and specific tools / devices available.
A different CuC occurs when I’m not in the ambulance anymore but in Emergency Care Unit, where my information needs vary and where I have other tools / devices available.
Another CuC is when a different kind of clinician is involved, in a different environment; once again, the required information is different.
Eventually, another CuC is when the patient has the same disease but the involved clinician is his family doctor doing a routine follow-up in his outpatient clinic, with no specific symptoms reported by the patient.

What is defined as

“Clinical Use Cases”

The Clinical Knowledge Portal permits to link the CuC with 3 main information sets: the clinical concepts (archetypes) which must be collected when the CuC occurs, the set of clinical concepts to be displayed and the set of recommended actions (orders, therapy, nursing activities, etc.), even collected from existing certified clinical sources, if available.
From the point of view of everyday practice, the use of CuCs is very simple. When a clinician is treating a patient with a specific CuC and he needs support to recover the most recent clinical guidelines, he can search the CKP through his EMR tool, where he will find many different CuCs, with different levels of maturity, with the possibility of identifying the most suitable for the patient’s clinical context.
In case the used EMR belongs to Dedalus Dfour line (but the tool is opened to any product on the market) he will be able to do much more: he will be able to immediately download the CuC, which will dynamically configure the D4 – EMR on the basis of the definitions set specified in the CuC; the EMR will then allow the clinician to view the useful information, collect the necessary pieces, plan actions on the patient consistent with the clinical best practices / guidelines.
The CuCs search is simple and effective. CuCs are created, voted and validated by clinical communities and clinicians are always able to see who did what, thus having all the necessary information to choose the most appropriate CuC.

Sharing quality data

One point more even for research

The CKP has a special value even for the management of Clinical Trials. Clinical Trials are currently very complex. Because of EMRs’ difficulty in collecting homogeneous clinical information, doctors doing research are forced to type data into basic software dedicated to Clinical Trials, thus leading to a double data entry, with the risk of introducing errors.
Thanks to the CKP, doctors wishing to enroll a patient for a Clinical Trial can access the CKP for the specific use case, retrieving the data scheme to be collected in their usual EMR and the required actions. When necessary, the data collected in their EMR can be transmitted to the Clinical Trial repository, with an automatic transposition of the codification.
This function considerably shortens the data collection time in clinical trials, strongly improving their quality: a precious result for research activities. The CKP is not magic. It is the result of a collaborative approach amongst clinicians who work on a shared tool to describe and share knowledge through “clinical communities”.

The value of “Clinical Communities”

Taking care of people, in a collaborative way

Clinical communities propose, vote and validate the clinical use cases and the clinical concepts archetypes, mapping them for more than one codification system (such as Snomed, Loinc, Cdisc, etc.). A clinician can join several clinical communities: those of his clinical society, the international one, a community of the hospital in which he works, the community of a specific school of thought, and so on. A community may be joined after invitation of the founder and its results will be enjoyable by members only, or it could be open to everybody and the same results will be available to anybody wishing to use them. Besides these two opposite models, communities with combined mechanisms can be created. Big private and public companies producing validated and/or certified knowledge could use the CKP as operational tool for supplying the main EMRs used in the world.

Decision support tools

The image knowledge base

The CKP is a big container of multimedia contents with the possibility of tagging them according to clinical compliance criteria. Such decision support system can be easily fed by all the operational tools used by professionals in the diagnoses and care process.
It is possible to create databases of documents, texts and videos referred to clinical use cases, which can be retrieved in the precise moment in which the clinician is working in such context.
According to the logic of open or closed communities, the above mentioned knowledge base can be created and made available only to the structure in which the professional works, becoming then an internal tool, or it can be made available to open communities thus increasing the number of records.
Thanks to the CKP, the major international producers of knowledge databases who offer decision support system services and products, have from today a tool natively integrated with application products, making the contents usable in the professionals’ work flow.

Beyond Business Intelligence

The Population Health Management

The collection of a huge quantity of clinical information with identical meanings from different EMRs or HISs is extremely complex, long and expensive.
Thanks to the normalization engines based on the CKP, it becomes very simple to collect non homogeneous data and represent them with very powerful tools in order to create dashboards typical of the Population Health Management; this is valid for both clinical and healthcare processes, and it also offers the possibility of building information displays combining different logic sources.

The community of communities

The Clinical Revolution

The CKP is also a container of tools for the cooperation amongst all members of the various communities, with a set of functions aimed at supporting a network of professionals.
Blog, Chat and Forum sections, each accordingly to its own modalities, are tools for the interaction between all the portal members and between members of the specific communities.
Furthermore, it is a container of information related to the knowledge diffusion treated in typical settings such as conferences, publications, events etc.
It also offers training and helpdesk functions, in order to make all the CKP’s tools user-friendly.

October 7, 2019

The Clinical Revolution

Monday 7 October 2019, at 10h00, at “Teatro del Maggio Musicale Fiorentino” in Florence. An event organized by FPA with Dedalus unconditional support.

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