Data in the service of the Patient is Imporving Patient Outcomes and Patient Safety with Better Data

1. Data in the Service of the Patient: Improving Patient Outcomes and Patient Safety with Better Data Greg Adams Vice PresidentWoltersKluwer | UpToDate gregory.adams@wolterskluwer.com

2. Doctors Have Clinical Questions Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a question Answering all clinical questions could change 5to8 patient management decisions each day Physicians have approximately 11 clinical questions a day 40% of the time, the clinician knows the answer • Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218; • Osheroff, JA. Ann Intern Med 1991:575; Ely, JW. J Am Med Inform Assoc 2005; 12:217; • Gorman, PN. Med Decis Making 1995; 15:113.

3. Staying on top of Medical Knowledge In 1965, only 39 randomized trials werepublished in medicine. In 2011, therewere 21 000, which poses a seeminglyinsurmountable information challenge for clinicalprofessionalswhowant to staycurrentwith important information. There istoomuch information to be able to manage or digest.

4. Clinical Decision Support: Getting It Right • In the Right Context & Format • The Right Guidance • At the RightTime • The Right Decision

5. The Most studied Clinical Decision Support System Over60 independentstudies • Have shownthatUpToDate has a direct impact on quality of care and clinicaloutcomessuch as a reduction of • complications, • mortality, • and costs. • We invite you to review the study data yourself: http://www.uptodate.com/home/research

6. UpToDate Changes Clinical Decisions 37% Researchers at Singapore’s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions… • Phua J, See KC, Khalizah HJ, et al. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53:116.

7. Use of UpToDate Associated with Improved Outcomes Solucient1 studied the impact of UpToDate on length of stay, complications, and patient safety2 Significantly shortens length of stay Significantly lowers adverse outcome rates Significantly lowers complication rates • Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospitals. • Bonis PA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length ofstay among Medicare beneficiaries in acute care hospitals in the US. Int J Med Inform 2008; 77:745.

8. Researchers at Harvard University FindUpToDate Associated with Improved Outcomes Use of UpToDateAssociated with... • Improved Quality • Every condition on Hospital Quality Alliance Metrics • Shorter Lengths of Stay • 372 000 days over 1 year • Lower Mortality Rates • 11 500 lives over 3 years • Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. • J Hosp Med 2012; 7:85.

9. Economic Impact of UpToDate at Salford Royal NHS Foundation Trust Forrester Research found Salford Royal NHS Foundation Trust (SRFT)recovered the costs of UpToDate in 90 days ROI Benefits Included: • Staff productivity • Diagnostic test efficiencies • Improvements in the quality of care 90 = days • Source: November 2011, Forrester Research: The Total Economic Impact Of UpToDate’s Clinical Decision Support System For Healthcare Institutions: • A Case Study Of Salford Royal NHS Foundation Trust in the UK

10. UpToDate around the world 30 000hopitals and clinics in 174 countries use UpToDate UpToDate has national contracts with the governments of Norway (2010), Iran (2011), Spain (2013), SaudiArabia (2013), Oman (2014), and Jordan (2015) to standardize care based on UpToDate content. In other countries, such as the USA, The Netherlands, Switzerland, or Luxembourg,UpToDate is used in all hospitals.

11. Integrating Clinical Decision Support in the Workflow • In the Right Context & Format • The Right Guidance • At the RightTime • The Right Decision

12. The Most Valuable HIT Initiative for Patient Care Which IT initiative produces the greatest benefitto the quality and safety of patient care? Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127) • Source: UpToDate individual subscriber survey 2012

13. Increased Clinician Satisfaction with the EHR Users said that having UpToDate embedded in their EHR 201191% Is important to patient care 201189% Enhances satisfactionwith their EHR Encourages utilizationof their EHR 201140% • Source: July 2011 Clinicians Survey N = 1228

14. Increased Clinician Satisfaction with the EHR Users said that having UpToDate embedded in their EHR 201593% Is important to patient care 201591% Enhances satisfactionwith their EHR Encourages utilizationof their EHR 201547% • Source: July 2015 Clinicians Survey N = 2526

15. Conclusion • Based on our experience in over 30 000 hospitals around the world, we are convinced that full use of REAL Integrated Clinical Decision Support would help: • Improve quality of care • Improve medical knowledge • Reduce complications • Reduce errors • This will help save more lives • This will help save more money.

16. Better Decisions,Better Care