# Presentation: 136996

## Technology Tools for Prevention

- Carolyn Clancy, MD
- Director
- April 16, 2003

## CASE PRESENTATION

- “Dorothy*”, a very obese 32 year old women, is seen for a suspected UTI and found to have diabetes
- Her physician provides information about diet and exercise – but is only cautiously optimistic
- One month later, Dorothy returns, having lost 30 lbs – and shows Dr. C how she is using a customized application for her Palm Pilot to track her progress with diet and exercise

## Prevention in Clinical Settings

- Patients are uniformly enthusiastic about prevention
- Physicians report superb knowledge of evidence-based recommendations AND believe they routinely provide preventive services to their patients
- _BUT_: gaps in delivery of recommended preventive services persist

## Barriers to Delivering Clinical Preventive Services

- Office barriers
- Lack of knowledge
- Lack of motivation, not ready for change
- Lack of effective teamwork
- Clinical setting focused on illness and treatment rather than wellness and prevention
_**Inadequate systems for delivery, tracking, and followup for preventive services**_

**Notes:**
How can offices integrate the delivery of preventive services into day-to-day operations? 

## Slide 5

## “We have wonderful technology, 

**but some grocery stores have better **
**technology than our hospitals and clinics.”**

- Secretary Tommy Thompson
- Chicago Medical School Commencement
- June 7, 2002

## The Potential of IT

- Support faulty or overloaded memories
- Decision support systems could help overcome poor judgment
- Email could enhance inadequate communication among providers and patients
- The public and purchasers could become informed consumers by tapping into web sites with provider performance information

## A Continuum of Clinical Decision Support

**Access to Information**

**Guided Choices**

**Knowledge-**
**based Prompting**

**Understanding**
**Clinical Practice**

- Making Informed Care Decisions

- Making the Right Choice Easy in Taking Action

- Making the Right Decisions about What to do

- Making Care Better

- Perreault L, Metzger J., JHIM Summer 1999

## IT Can Improve Quality

*Safety*: computerized physician order entry reduced adverse drug events by 55% *(Bates)*
*Effectiveness*: _reminder systems improve compliance with clinical guidelines and improve delivery of preventive services_
*Patient-Centered*: Internet can support clinical knowledge, online support groups, and improve health care outcomes *(Gustafson*)

## IT Can Improve Quality

*Timeliness*: _mothers receiving computer-generated reminders had 25% higher on-time immunization rate for their infants_ *(Alemi)*
*Efficiency*: 9% of redundant lab tests at a hospital could be reduced using a computerized system (*Bates)*
*Equity:* if available, access to internet-based health information could help to reduce disparities and access to needed health services

## “Potential is what you have when you haven’t done it yet” 

- 				Darrel Royall
- 				University of Texas
- 				Football coach

## Clinical IT inAmbulatory Settings

- PDAs widely used...
- 35% of MDs had one in 2002, 55% used them to access drug information
- But EMRs not widely adopted:
- 17% of PCPs, 12% of specialists in 2001
- And e-Rx not widely adopted:
- 9% of PCPs, 6% of specialists in 2001

## Slide 13

## Bioterrorism Preparedness: Improved  Coordination Through IT

**Front-Line Clinical Providers**

-    Primary care clinicians
-    Managed care organizations
-    Emergency Departments
-    Hospitals

**Public Health Infrastructure**

**IT**

-    Public health departments
-    State laboratories
-    Emergency preparedness

## Secretary ThompsonMarch 21, 2003

*In the modern era, every century has had its major  *
*advance that has brought medical science another *
*giant step forward.  In the 18th century, vaccination *
*offered precious immunity from age-old plagues.  *
*The 19th century introduced knowledge of bacteria *
*and disease transmission.  The 20th century brought *
*us the miracle of antibiotics.  What will the major *
*advance of the 21st century be?  I am convinced that *
*the medical revolution of our children’s lifetimes will *
*be the application of information technology to health *
*care.*