Month: August 2017

#VR #AR can increase efficiency and reduce cost in medical education #meded by Dr. Vikram @drvikram

Virtual Reality and Augmented Reality has the potential to transform key areas in healthcare. Medical Education, Rehabilitation, supply chain the list is endless and what is limiting us is our own imagination.

Last week I was speaking at the IT Healthcare Summit on the potential for VR/AR to transform healthcare. I also shared my views on this post before the conference. In my discussions with the delegates, I realized that the foundation of medical education in India can be improved drastically. One just needs to look around medical colleges in India to understand the state of the dissection halls there. 


Often, they suffer from the lack of cadavers so essential for understanding key aspects of human anatomy. This leads to a weakness in fully grasping aspects of human anatomy that would help them become better doctors and improve care outcomes. A light-hearted representation of this was seen in the movie “Munna Bhai MBBS”. Often the students must share a single cadaver and this does not help the students at all. But VR/AR can change that.

A pilot at Miami Children’s Hospital saw that the retention in students who were taught through AR/VR was 80% as compared to 20% for those who were taught through traditional methods. In India SRM University in Chennai and Global Hospitals in Hyderabad have been piloting AR/VR 

Another area where AR/VR played a critical role was in training surgeons and physicians on complex procedures like “Tracheal Intubation”. Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction. (Source: Wikipedia)

A major hospital chain increased the efficiency of their surgeons by 35% by using simulation of tracheal Intubation using VR/AR vs a specialized training that would have required them to travel to a special center. The cost savings were more to the tune of 500% using this method.

But the major effect of AR/VR would be in rehabilitation. Already pilots have been conducted in areas like PTSD by the US Army. The Indian Spinal Research Institute is already using VR/AR technology to use it in the physio therapy process for rehabilitation post-surgery.

The potential is immense and the use cases are still building up. But what’s stopping us ? Well I look forward to your comments and suggestions to get us moving in this direction. Looking forward to your views and suggestions on the same. 

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Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.
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Internet of Things #IoT : Healthcare & Medical by @vsolank1

Application of “IoT”, the latest buzz word as many would like to call it, are numerous and have been covered under the topics below

















Healthcare industry is one the largest in any country both in terms of the required reach to the masses and in terms of per capita budget. Human beings save money to live comfortably, to get their child married, to buy a house and last but not the least to pay for medical bills. As per the latest reports on USA health stats only 21 out of 100 people (< 65 age) have medical coverage. But the spend on prescription drugs is rapidly increasing from 2004 ($192 B) to 2014 ($297) however maximum of this spend is funded by private savings. Scenario is not much different in other developed countries.















On the other end if we look at developing countries like India, then as per WHO the top 10 reason of deaths in India includes heart diseases, obstructive pulmonary, stroke and so on.
















Other emerging and under developed nations will have similar stats or even worse. So why do I think IoT based solutions can improve these stats in a positive way? Let’s see some of the health and medical related IoT apps, devices, solutions and monitoring systems that can have a cost effective impact on these issues. Additionally I think if Government increase its spend on R&D it can immensely help to make the solutions more scalable and deployable.

Proactive Health Solutions

Yolo Health ATM is an integrated health screening kiosk with integrated medical devices such as Glucometer, BP monitor, BMI calculator, etc, and also staffed by a medical attendant. This can be next generation kiosk that will help people, short on time, to be more proactive about their health. This also holds potential to be deployed in rural areas where primary healthcare penetration is limited. Wearables such as FitBit, Apple Watch and various health bands are not new to us and they help a great deal in tracking your activities in real time.

Remote Patient Monitoring

Healthcare providers and family members always wish to monitor the health of the patient in real time. Pre and Post operative measures are taken to monitor patients health and IoT can enable solution that can allow to achieve this more efficiently and economically. Real time information, published through cloud, will help caregivers to make informed decisions and diagnosis, which are more evidence based. In the current world it is a mixture of symptoms, patients reactions and doctors gut feel which sometimes leads to trial and error diagnosis. IoT can provide real time data and more accurate information at the right time, which can revolutionize the healthcare market. This will also help in preventive disease management, reduced health care cost, enhanced patient experience, reduced errors and shorter recovery cycle.

Drugs Management

From the point of improving process on the manufacturing and R&D facilities using sensor based proactive maintenance systems and real time information feeding pipes to improving the tracking of drugs from the point of distribution to the point of purchase – IoT has a big role to play. While I won’t go deep as they are not directly healthcare related but I would like to mention – supply chain management, fleet management, asset tracking, temperature and humidity monitoring and inventory management are all the categories of solutions that can help in this area.


Forbes article talks about partnership between Qualcomm and Philips to focus on creating healthcare IoT solutions such as connected dispensers for medicines, biological sensors, self care glucose meters for diabetics to an integrated cloud system for health record monitoring. Connected Medical Equipment which can transmit the data captured through sensors and of course from the patient directly onto the cloud for transparency and monitoring purpose as described here is a very handy use case for IoT.

Personal Health Data Security

However the concern many of us is security and safety of that sensitive private data about my health to be lost, hacked, misused by anyone. What if the data is captured and used for targeting ads at me? I think this is fine because it will only SPAM my life but not endanger it. Healthcare IoT Security Risk is a worth short article to read. LinkLabs also talks some of these use cases and concerns nicely.

#IoT, #M2M, #Healthcare, #Medicine, #Wearable, #Remote Patient Monitoring

Author
Vinay Solanki

Vinay has 10+ years of experience in Internet of Things(IoT), WiFi as a Service, Mobile money, Global projects and team management, client engagement, and consulting.

Currently he leads IoT and WiFi business for Bharti Airtel, aggressively driving business opportunities in this space. Prior to this he was the Global Head for revenue assurance and fraud management for Airtel Money (a mobile wallet) managing 17 countries in Africa and pan-India, focusing on building comprehensive financial risk picture for Airtel Money.

How Virtual Reality #VR and Augmented Reality #AR is transforming Healthcare by Dr. Vikram @drvikram

Digital is transforming healthcare. It is creating new channels for improving patient experience, creating better clinical processes and engaging doctors and other para-clinical staff like never before.


It is also creating new models for areas like medical education, rehabilitation and managing supply chain. In these there key areas Augmented Reality (AR) and Virtual Reality (VR) are playing a key role. But first let’s start with the definition and differences between AR and VR.


Augmented Reality or AR is a live direct or indirect view of a physical, real-world environment whose elements are “augmented” by computer-generated sensory input such as sound, video, graphics or GPS data. So the game Pokemon Go is a good example of AR. (Source: Wikipedia)

While VR on the other hand VR- Virtual reality (VR) is a technology that uses Virtual reality headsets, sometimes in combination with physical spaces or multi-projected environments, to generate realistic images, sounds and other sensations that simulate a user’s physical presence in a virtual or imaginary environment. (Source: Wikipedia) So VR requires a headset specialized for the same. 

The Industry seems to be taking notice of this emerging area. These are some numbers from the industry

1. More than 150 of Global Fortune 500 investing in AR/VR
2. VC and corporate investment upto $2.3 Billion in AR/VR Startups 
3. IDC projects revenues from AR/VR to grow from $5.2 billion today to $162 billion by 2020

But why are the key reasons why AR/VR has reached this level

1. We have more computing power than ever before. Today we have GPU’s and TPU’s that put immense computing power at our disposal
2. There is a explosion in digital data. By 2020 it is believed that we would have created 40,000 Exabyte of data
3. Finally programmers today are writing better algorithms. That is why machine learning is mainstream today

So what are the implications of the same in healthcare?

There are clearly implications in Medical Education. Pilots conducted in Miami Children’s hospital have shown an 80% increase in retention while using AR/VR. There are other pilots involving treating war veterans using VR for Post Traumatic Stress Disorder.

I will be speaking on this topic on, 23 Aug 2017, at the IT Healthcare Summit 2017 in Bangalore. It will be interesting to discuss and other topics on digital health and how it is transforming healthcare in India. Looking forward to hearing your views on the same. 

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Dr. Vikram Venkateswaran

Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.
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Order Sets: A POKA-YOKE for Clinical Decisions by Dr. Ujjwal Rao, @DrUjjwalRao – Part 2/2

The full potential of a CDSS can be realised when it is seamlessly integrated into the clinical workflow and is evidence-adaptive


In continuation to the the part one of the article, in the part 2 of the “Order Sets: A POKA-YOKE for clinical decisions” Dr. Rao is

ADDRESSING THE KNOWLEDGE GAP THROUGH CDSS:

THE POWER OF ORDER SETS

A “Physician Order” is a communication directing a particular service or action to be taken in the care of a specific patient. Medications, diet, physical activities, laboratory tests, radiologic studies, therapies, treatments…all are among the literally dozens of orders written to guide the care of each and every patient by the physician throughout an ordinary day. 


Thus the physician ordering process is complex and time-consuming. In addition, the continuous explosion of new evidence-based information results in the reality that providers often make mistakes, at best failing to provide the highest value care, and at worst causing preventable injuries and deaths. And while computers can address avoidable mistakes from the most mundane sources (such as illegible hand-writing), the greatest threat to patient safety and cost waste is the knowledge gap.

Fortunately, when a physician realises that he or she needs information, CDSS reference solutions provide access to current, credible, evidence-based knowledge (either integrated into an EHR, available over the internet, or in print). Thus by their very nature, reference solutions require that the physician knows he or she doesn’t know something.

But medical knowledge is doubling every two months. Clearly many times the physician doesn’t know what he or she doesn’t know… Thus patients are placed at risk because physicians are unaware that new information and knowledge is available.

Order sets are the best solution to this dangerous problem. Order sets automatically push current, credible, evidence-based information specific to the patient’s clinical history and current clinical status directly to the physician at the point of care. Take for example:

A 52 year old man is admitted for surgical treatment of a right-sided colon cancer. His surgeon regularly operates on such patients, removing that segment of large intestine harboring the malignant tumor. But like many, this surgeon is unaware that this patient’s young age and tumor location suggest an inherited syndrome requiring a much more extensive operation to prevent a second cancer over the next decade. 

If the surgeon “doesn’t know what he doesn’t know,” how can he look up “inherited colon cancer” in his CDSS reference solution? He can’t. But when the patient is admitted to the hospital, order sets specific for colon cancer patients are automatically pushed to the physician. These order sets can be commercially available or can be created by the hospital, healthcare system, regional, or international experts (physicians, nurses, pharmacists, etc.) and represent the evidence-based guidelines and information on colon cancer. Thus the order sets educate the surgeon and recommend that he order a simple blood test to check for the inherited cancer syndrome. If integrated within an EHR, the physician can actually click on embedded hyperlinks to view the EBM sources of the recommended orders. 

The surgeon will likely accept the recommended order and confirm that the patient suffers from the syndrome. Then the surgeon can search the CDSS reference solution and rapidly learn the appropriate surgical procedure for the patient, as well as how to test and screen family members for the inherited syndrome.

Thus order sets address the knowledge gap, including providing the physician with what he “doesn’t know he doesn’t know.”

But there is a risk with evidence-based order sets because clinical knowledge is advancing exponentially. When order sets are implemented but inadequately maintained, they drive providers to practice outdated medicine on a widespread basis [14]. Thus it is critical for evidence-based order sets to include a knowledge-base that continually reflects current evidence. In the near future, evidence-adaptive order sets will be empowered through advancements in machine learning and artificial intelligence. 

Today, much evidence adaption is performed manually, with professionals (using computer systems) to rapidly review new EBM for updating order sets. CDSS which incorporate order sets can reduce medication errors up to 81% [15], and today, order sets represent the most impactful CDSS solution to empower physicians in delivering the highest quality, most cost-efficient evidence-based patient care.

THE ECONOMIC ARGUMENT FOR ORDER SETS

One of the greatest challenges of healthcare reform worldwide is the reluctance of those paying for technology to invest in EBM and CDSS. The question, of course, is return on investment (ROI). However, the potential ROI of order sets through reduction in adverse drug events (ADE) and unnecessary diagnostic tests alone is projected to be enormous (in one academic hospital estimated at up to $10 million [16]). Although there remains a dearth of high-quality evidence on the cost impact of order sets, many operational benefits which intuitively link to cost reduction have been demonstrated. Including: reductions in overall length of stay; postoperative length of stay; and the total cost for multiple surgical procedures, including total knee arthroplasty, appendectomy, total laryngectomy, cholecystectomy, carotid endarterectomy, gastrectomy, inguinal hernia repair, and colon surgery [17].

University of Kentucky Healthcare (UKHC) adopted a well-known commercial order sets solution in 2013 [18], demonstrating improvements in compliance to standard practices and elimination of unnecessary tests. At the University Hospital Frankfurt in Germany, implementation of order sets focused on gastroenterologic care reduced average length of stay and overall physician ordering time while elevating physician satisfaction scores for computerised ordering [19].

ORDERING BETTER CARE: CONCLUSION

The multi-factorial healthcare dilemma including preventable medical errors, the information explosion, slow knowledge diffusion, a growing regulatory environment, and increasing litigation has rendered Clinical Decision Support Systems indispensable. 

Order sets are designed not only to answer questions that the physician is asking, but also to answer critical questions that the physician doesn’t know he or she should be asking. Founded in current, credible, evidence-based information, order sets are the most impactful of physician CDSS solutions. 

Combined with reference and other CDSS solutions, order sets have the potential to empower physicians in providing the safest, highest quality, most cost-efficient healthcare; that is, a truly reliable Poka-Yoke.

Suggested Reading

Dr. Ujjwal was also asked in a recent interview with BioSpectrum India, to share more about the challenges, and most urgent needs in today’s healthcare systems. 

Some might argue that technology is the way forward but Dr. Ujjwal is of the view that technology is only the vehicle through which information and knowledge is delivered. High-quality and consistent care needs to be driven by both tech and evidence-based medicine. The full article can be read online here: 

http://www.biospectrumindia.com/interviews/71/9023/evidence-based-healthcare-is-the-need-of-the-hour.html


References
[13]: Sackett, David L., et al. “Evidence based medicine: what it is and what it isn’t.” Bmj 312.7023 (1996): 71-72.

[14]: Bobb, Anne M., Thomas H. Payne, and Peter A. Gross. “View point:
controversies surrounding use of order sets for clinical decision support in
computerised provider order entry.” Journal of the American Medical
Informatics Association 14.1 (2007): 41-47.

[15]: Bates, David W., et al. “The impact of computerised physician order entry on medication error prevention.” Journal of the American Medical Informatics
Association 6.4 (1999): 313-321.

[16]: Glaser, J., J. M. Teich, and G. Kuperman. “Impact of information events on
medical care. “Proceedings and abstracts of the 1996 Healthcare Information
and Management Systems Society Annual Conference. 1996.

[17]: Ballard, David J., et al. “The Impact of Standardised Order Sets on Quality and Financial Outcomes.” Advances in Patient Safety: New Directions and
Alternative Approaches (Vol. 2: Culture and Redesign). Rockville (MD): Agency
for Healthcare Research and Quality (US); 2008

[18]: Elsevier Clinical Solutions. How Elsevier Helped University of Kentucky Health-Care® Bring Order to Their Order Sets. N.p.: Elsevier Clinical Solutions, 2016. Print.

[19]: Zwack, Laura. Electronic Order Entry with Order Sets at University Hospital Frankfurt.Munich:Elsevier, 2016. Print.

Author
Dr. Ujjwal Rao

Dr. Ujjwal Rao is Senior Clinical Specialist in Integrated Decision Support Solutions, and is based in New Delhi, India. He provides strategic counsel to health providers on designing world-class clinical decision support systems with Elsevier’s comprehensive suite of current and evidence-based information solutions that can improve the quality and efficient delivery of healthcare.

An experienced emergency physician, executive, clinical informaticist and technology evangelist, Dr. Rao has a decade of experience serving in trust and corporate hospitals in various roles ranging from clinical administration, hospital operations to quality & accreditation. In his former positions, Dr. Rao led EHR implementations for large hospital groups and designed bespoke healthcare analytic solutions to raise profitability.

His passion to see transformation through technology led him to volunteer as a quality consultant with the United Nations. He also currently serves as an Assessor on the Panel of the Quality Council of India for the National Healthcare Accreditation Standards body, NABH.

Dr. Rao obtained his degree in Medicine and then specialized in Hospital and Health Systems Management, Medical Law and Ethics before completing his PhD in Quality and Medical Informatics.

Order Sets: A POKA-YOKE for Clinical Decisions by Dr. Ujjwal Rao, @DrUjjwalRao – Part 1/2

Poka (unintended mistake) Yoke (avoid) is the Japanese equivalent for “error proofing”.  
This Lean Manufacturing strategy is more relevant than ever in healthcare today. Why?

FIRST, DO NO HARM
The Supreme Court of India recently ordered one of the largest compensations so far in the country to a girl who lost her vision at birth in a case of medical negligence. The girl, who is now 18 years old, was born prematurely at a government hospital but was discharged from the hospital without a retinopathy test, a must for prematurely born babies. By the time the family discovered the lapse, the girl had lost her vision [1].


Fentanyl is a potent opioid medication used as part of anesthesia. A hospital pharmacist received an order for a ‘fentanyl drip 5,200 mcg per hour,’ which a nurse had just transcribed after accepting a telephone order. The pharmacist called the nurse to clarify the dose. The nurse confirmed that, although the dose was large, she had “read back” the order to the anesthesiologist several times to make sure she had heard the dose correctly. The pharmacist called the anesthesiologist himself, only to find that the intended order was for a fentanyl drip 50 to 100 mcg per hour [2].

The frequency of preventable medical errors resulting in patient injury and death is staggering. It is estimated that for every 100 hospitalisations, approximately 14 adverse events occur, translating to roughly 43 million avoidable patient injuries worldwide each year. In terms of quality of life for those inadvertently hurt: the loss of nearly 23 million years of healthy life [3]. And avoidable medical errors don’t just injure patients. Between 200,000 and 400,000 patients die every year in the United States as a result of preventable medical errors, [4] making avoidable hospital deaths the number three killer of American adults. 

These stunning figures clearly directly oppose the fundamental principle of medicine: First, Do No Harm.

THE MEDICAL INFORMATION EXPLOSION

Based on an extrapolation of a 2011 study [5] the stacking of CD-ROMs holding all of medical information available by 2020 would reach from earth to the moon and a half of the same distance beyond. And the rate of our medical knowledge growth is hard to fathom: by 2020, all that humanity understands about the body, health, and healthcare is projected to double every 73 days [6].

Just to keep up with the Primary Care literature would require a General Practitioner to read for 21 hours every single day [7]!

DIFFUSION OF KNOWLEDGE TAKES (A LONG) TIME

“Diffusion of medical knowledge” is the acceptance of new scientific discoveries into clinical practice. And such diffusion takes an extraordinarily long time… 

Back in the early 19th century, the idea of hand washing prior to examining pregnant women was considered revolutionary, and it was only after decades that hand washing to prevent puerperal fever was universally accepted in clinical practice. But you don’t have to look so far back. Take the case of β-blockers, a class of drugs whose beneficial effect in heart attack patients was established almost 30 years ago. Yet today, β-blockers are still widely under-prescribed [8]. 

The tragic reality is that even today, it takes an average of 17 years for only 14% of new scientific discoveries to find their way into daily clinical practice [9]. Thus our patients routinely wait to be prescribed drugs or undergo procedures or interventions proven effective decades earlier.

In the end, we have a disastrous collision of realities: all medical knowledge will soon be doubling every 73 days, while it will likely take decades for any new knowledge to routinely be incorporated into patient care.

GOOD CARE PAYS – POOR CARE COSTS

Healthcare is being reformed globally. In particular, the payment models are increasingly moving away from Fee-for-Service (FFS) to Pay-for-Performance (P4P). Full-fledged or partial P4P models are now increasingly being adopted by most of the developed nations, including the USA, UK, and Australia, among others. P4P models aim to encourage care providers (individuals and institutions) to provide better quality care by linking reimbursement (provider payments) to clinical and performance outcomes. The models also penalise medical errors, adverse outcomes, and excessive diagnostic and treatment costs. Thus in the P4P model, providers and healthcare systems risk significant financial penalties if they are unable to avoid adverse clinical outcomes and unnecessary tests and procedures.

To summarise, healthcare is now faced with a new dilemma: a significant burden of preventable medical errors, an explosion in the rate of medical information growth, and the historically slow adoption of new discoveries. Add to this an expanding regulatory environment demanding high-quality care plus the rapid rise of medical malpractice litigation and providers must ask themselves, “Is the practice of medicine no longer humanly possible?”

A SOLUTION TO THE MULTI-FACTORIAL

HEALTHCARE DILEMMA


So how do we reduce (and eventually eliminate) preventable medical errors? Providing current, credible, evidence-based information and guidance at all points of care is a cornerstone in the answer to this question. In the area of medication errors (a common form of preventable patient injury and death), a system analysis of a large sample of serious mistakes [10] identified 16 major types of causative system failures. All of the top eight were deemed preventable through the provision of better medical information.

Today, Clinical Decision Support Systems (CDSS) are being hailed as a major
weapon in the battle against preventable medical errors [11]. And at the heart of the most impactful CDSS lies evidence-based medicine (EBM). Advocated as a method to improve clinical outcomes [12], the incorporation of EBM into powerful CDSS has the potential to transform healthcare safety and quality, a true healthcare Poka-Yoke! As such, EBM is the foundation of evidence-based care, broadly defined as patient management through the conscientious and judicious use of current best evidence from clinical care research integrated with individual clinical expertise [13]. And to complete the picture, evidence-based care should also include patient preferences, input, and active participation. 

Clearly based on the foundations of the healthcare dilemma, in order to be safe, effective, and efficient, today’s physicians, nurses, pharmacists, therapists, patients, and other healthcare stakeholders must have real-time, mobile access to current, credible, evidence-based information. While many have been disappointed that Electronic Health Records (EHRs) have not on their own solved the dilemma, it is critical to appreciate that technology is the vehicle through which EBM and other information is delivered, not the primary source of information itself. In the absence of technology (in fact, long prior to the development of computers and the internet), current, credible, evidence-based information allowed the world’s leading healthcare providers to deliver high quality, evidence-based care.

Today’s technology represents a great leap forward in accessing high value care information at points across the globe, with the knowledge provided by EBM integrated into EHRs and available via “the cloud,” all as part of CDSS.

Evidence-based care is most impactful when current, credible, evidence-based knowledge is incorporated into the provider workflow; thus, the most advanced CDSS are “workflow-integrated.” More importantly, these systems are evidence-adaptive [12]; that is, the clinical knowledge within the CDSS continually reflects current EBM from the research literature plus sources of practice expertise. 

The full potential of a CDSS can be realised when it is seamlessly integrated into the clinical workflow and is evidence-adaptive [12].

Stay tuned for the Part TWO of the Blog from Dr. Ujjwal Rao.

Suggested Reading
Dr. Ujjwal was also asked in a recent interview with BioSpectrum India, to share more about the challenges, and most urgent needs in today’s healthcare systems. 

Some might argue that technology is the way forward but Dr. Ujjwal is of the view that technology is only the vehicle through which information and knowledge is delivered. High-quality and consistent care needs to be driven by both tech and evidence-based medicine. The full article can be read online here: 
http://www.biospectrumindia.com/interviews/71/9023/evidence-based-healthcare-is-the-need-of-the-hour.html

References
[1]: Vaidyanathan, A. “Supreme Court Orders Compensation of Rs. 1.8 Crore to
Chennai Girl in Medical Negligence Case.” NDTV, July-Aug. 2015. Web.
http://www.ndtv.com/india-news/supreme-court-orders-compensation-of-rs-1-8-crore-to-chennai-girl-in-medical-negligence-case-777238

[2]: Institute for Safe Medication Practices. “Safety Briefs: Single Digits.”
Medication Safety Alert! 9 (July 2004): 1.

[3]: Jha, Ashish K., et al. “The global burden of unsafe medical care: analytic
modelling of observational studies.” BMJ quality & safety 22.10 (2013):
3809-815

[4]: James, John T. “A new, evidence-based estimate of patient harms associated with hospital care.” Journal of patient safety 9.3 (2013): 122-128.

[5]: Hilbert, Martin, and Priscila López. “The world’s technological capacity to
store, communicate, and compute information.” Science 332.6025 (2011):
60-65.

[6]: Densen, Peter. “Challenges and opportunities facing medical education.”
Transactions of the American Clinical and Climatological Association 122
(2011): 48.

[7]: Alper, Brian S., et al. “How much effort is needed to keep up with the
literature relevant for primary care?.” Journal of the Medical Library Association 92.4 (2004): 429.

[8]: Bradley, Elizabeth H., et al. “Quality improvement efforts and hospital
performance: rates of beta-blocker prescription after acute myocardial
infarction.” Medical care 43.3 (2005): 282-292.

[9]: Balas, E. Andrew, and Suzanne A. Boren. “Managing clinical knowledge for
health care improvement.” Yearbook of medical informatics 2000.2000 (2000):
65-70.

[10]: Leape, LucianL., et al. “Systems analysis of adverse drug events.” Jama 274.1(1995): 35-43.

[11]: Bates, David W., et al. “Reducing the frequency of errors in medicine using information technology.” Journal of the American Medical Informatics
Association 8.4 (2001): 299-308.

[12]: Sim, Ida, et al. “Clinical decision support systems for the practice of
evidence-based medicine.” Journal of the American Medical Informatics
Association 8.6 (2001): 527-534.

Author
Dr. Ujjwal Rao

Dr. Ujjwal Rao is Senior Clinical Specialist in Integrated Decision Support Solutions, and is based in New Delhi, India. He provides strategic counsel to health providers on designing world-class clinical decision support systems with Elsevier’s comprehensive suite of current and evidence-based information solutions that can improve the quality and efficient delivery of healthcare.

An experienced emergency physician, executive, clinical informaticist and technology evangelist, Dr. Rao has a decade of experience serving in trust and corporate hospitals in various roles ranging from clinical administration, hospital operations to quality & accreditation. In his former positions, Dr. Rao led EHR implementations for large hospital groups and designed bespoke healthcare analytic solutions to raise profitability.

His passion to see transformation through technology led him to volunteer as a quality consultant with the United Nations. He also currently serves as an Assessor on the Panel of the Quality Council of India for the National Healthcare Accreditation Standards body, NABH.

Dr. Rao obtained his degree in Medicine and then specialized in Hospital and Health Systems Management, Medical Law and Ethics before completing his PhD in Quality and Medical Informatics.

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