Using Evidence-Based Decisions to Support Gut Calls in the OR: Introduction to Case-Based Reasoning

Healthcare is being redefined to focus on quality outcomes at lower costs. With this growing stress on providers, the industry needs to look to new ways to utilize data to improve outcomes, while taking into account the rapid changes that can occur during a case. Situations in healthcare change quickly, and no matter how prepared physicians may be before surgery, the situation can shift dramatically on the operating table. Physicians need evidence-based support to make the smartest real-time decisions.

While there is something to be said for the instinct of physicians making gut calls based on experience, there is no substitute for data-backed, evidence-based information when making these calls. Many hospitals and physicians currently do not have the tools or technology to leverage the inordinate amount of data they produce to assist in making decisions in real time. With the hospital information system industry expected to spend $35 billion on IT by 2015, it's time to turn some of this attention to cost-efficient analysis of data to improve patient outcomes.

Preventable adverse events cost the healthcare industry $17 billion to $29 billion annually, and 50,000 to 100,000 people die each year in the U.S. as a result of medical errors. Hospitals must run just like any other organization, focusing on the business of care, and they cannot sustain care with these annual losses. The key to preventing these adverse effects, and saving both money and improving patient health, is looking to the past for guidance.

The medical profession has long used case studies as a way to learn from the past and has a tradition of publishing particularly interesting studies, which have provided valuable lessons for future treatment. With situations in the present often being similar to situations in the past, it's important to learn from these case studies and pull best practices and tactics from surgical procedures and techniques that resulted in positive outcomes in the past for use today.

Realistically, no single person can keep every relevant experience and case in their head, and it can be difficult to recall a past case during a procedure. This is where case-based reasoning comes in. A CBR platform can contain a large number of cases in a database. Instead of having a physician actively search for cases like with traditional knowledge management techniques, the CBR system uses multiple, heterogeneous data types about the patient to index the past experiences. This allows the system to use real-time data from the patient to continuously search the case database for past cases and relevant risk profiles, actively providing the physician with relevant cases with information they need to improve patient outcomes. By providing a realistic assessment as to whether a similar scenario is likely to occur in the future on the operating table, CBR empowers physicians with the evidence-based insight and foresight to make better, smarter, faster real-time surgical decisions to ensure positive patient outcomes.

How does CBR differ from the traditional predictive analytics technologies used by healthcare providers today? While predictive analytics solutions are valuable for analyzing historical data for patterns that can inform future medical decisions, they do not analyze data in real time or serve as decision support tools during a procedure.

Seemingly minor trends and symptoms can turn into major complications during surgery, if not identified and treated in time. CBR helps physicians identify these trends and symptoms early and suggests the best course of action to improve the outcome for the patient. By having accurate, evidence-based information at their fingertips, physicians are assured that if the current patient shows similar trends and symptoms as a past case where complications occurred, they have the necessary background information and best recommendations available in an instant. Better patient outcomes naturally result in shorter stays in the hospital, reduced costs and fewer lawsuits. Taking this into account, CBR is not only helping improve quality for patients, but also benefitting the provider's bottom line.

It's not difficult to see the connection between the success of physicians and their patients and the success of hospitals. With many healthcare providers struggling financially as they try to support an exemplary quality of care, physicians must look to their past successes and adverse events to enhance future performance. There's no substitute for individual skill and instinct, but a decision support solution like CBR can only help improve patient outcomes while reducing costs and enhancing the quality of care.

Frode Sørmo, Chief Technology Officer of Verdande Technology, holds a Masters and PhD from Norwegian University of Science and Technology in computer science with a specialization in artificial intelligence and case-based reasoning. As one of the founders of Verdande Technology, Mr. Sørmo developed the case-based reasoning technology, the core of the Edge platform. From 2006 – 2008, he led the software development team in developing the first prototype of DrillEdge Software. In 2008, Sørmo took on his current role as CTO in providing strategy on technology, research and product development.


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