evidence-based medicine, that one Boston-area insurer has agreed to waive the requirement for preapproval of procedures where the process is followed.
Used as a search engine, QPID can pull all the records for a given patient that contain the word "cancer," for instance. If a clinician searches for "*cancer" using QPID, it will also find records that don't contain that exact word, but do relate to the concept of malignant tumors. In addition to EHR records, it can search lab results containing diagnostic indications of cancer.
That's the Google part. To be clear, QPID doesn't actually use Google technology. Nor does it use CliffsNotes technology, but the QPID dashboard is designed to help a doctor be a quick study of a patient's condition. In this mode, rather than searching, the clinician is presented with a screen that can be customized by specialty showing an overview of all the most relevant information about that patient.
Instead of CliffsNotes, you might think of it as a sort of Google News -- all the top headlines for the patient. Except, instead of being classified into business and sports news, they're broken down, for example, by cardiovascular and pulmonary conditions, and by common warning signs such as chest pain. To get a better idea of how this fits into a practice, you can look at a goofy holiday video the QPID staff produced about diagnosing Santa's ailments with the help of the tool.
Another way Mass General has put the technology to work is by proactively checking for risk factors before performing a procedure. For example, the hospital schedules about 100 colonoscopies per day. It was having to cancel 10 to 15 of those because of risk factors that were unknown before the patient walked in the door and the doctor asked some questions, Doyle said. There are a half dozen of these risk factors. If a patient is on blood thinner medication, the procedure won't be performed, because if a polyp is found, the surgeon wouldn't be able to snip it without the risk of the patient bleeding to death. Using QPID to do a comprehensive records search, a nurse can discover that the patient has one of these risk factors and either cancel the procedure or, in the case of blood thinners, tell the patient to discontinue taking the medication for a couple of weeks prior to the procedure.
Similarly, a patient who has a pacemaker or any other metallic medical implant should never be given an MRI -- a diagnostic test that uses powerful magnets -- and QPID helps make sure clinicians are aware of such complications prior to the day of a procedure. In this way, Mass General has dramatically reduced the number of appointments that have to be canceled, Doyle said.
"It's pretty obvious EHR software was not made for physicians to practice," said Sid Govindan, another former Mass General radiologist, now serving as QPID's director of clinical content.
Often, the information doctors need to find is in structured fields, and they can only find it if they know exactly where to look. Further, even where structured fields are designated, they might not be used consistently. A do not resuscitate order might be recorded by checking off DNR on a form in some cases. In others it might be mentioned in a free-form physician's note. QPID helps make sure the information will be found either way, he said.
"EHRs today are like the Web before Google," Govindan said.
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