1. 0 Data in the Service of the Patient: Improving Patient Outcomes and Patient Safety with Better Data Greg Adams Vice President Wolters Kluwer | UpToDate gregory.adams@wolterskluwer.com

2. 1 Doctors Have Clinical Questions 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. Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a question Physicians have approximately 11 clinical questions a day 40 % of the time, the clinician knows the answer Answering all clinical questions could change 5 to 8 patient management decisions each day

3. 2 Staying on top of Medical Knowledge In 1965, only 39 randomized trials were published in medicine. In 2011, there were 21 000, which poses a seemingly insurmountable information challenge for clinical professionals who want to stay current with important information. There is too much information to be able to manage or digest.

4. 3 Clinical Decision Support: Getting It Right In the Right Context & Format The Right Guidance At the Right Time The Right Decision

5. 4 We invite you to review the study data yourself: http://www.uptodate.com/home/research Over 60 independent studies Have shown that UpToDate has a direct impact on quality of care and clinical outcomes such as a reduction of  complications,  mortality,  and costs. The Most studied Clinical Decision Support System

6. 5 UpToDate Changes Clinical 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. 37% Researchers at Singapore’s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions…

7. 6 Use of UpToDate Associated with Improved Outcomes 1.Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospitals. 2.Bonis PA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the US. Int J Med Inform 2008; 77:745. Significantly shortens length of stay Significantly lowers complication rates Significantly lowers adverse outcome rates Solucient 1 studied the impact of UpToDate on length of stay, complications, and patient safety 2

8. 7 Researchers at Harvard University Find UpToDate Associated with Improved Outcomes Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85. Use of UpToDate Associated 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

9. 8 Economic Impact of UpToDate at Salford Royal NHS Foundation Trust 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 Benefits Included:  Staff productivity  Diagnostic test efficiencies  Improvements in the quality of care Forrester Research found Salford Royal NHS Foundation Trust (SRFT) recovered the costs of UpToDate in 90 days 90 = ROI days

10. 9 UpToDate has national contracts with the governments of Norway (2010), Iran (2011), Spain (2013), Saudi Arabia (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. UpToDate around the world 30 000 hopitals and clinics in 174 countries use UpToDate

11. 10 Integrating Clinical Decision Support in the Workflow In the Right Context & Format The Right Guidance At the Right Time The Right Decision

12. 11 The Most Valuable HIT Initiative for Patient Care Source: UpToDate individual subscriber survey 2012 Which IT initiative produces the greatest benefit to the quality and safety of patient care? Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127)

13. Is important to patient care Enhances satisfaction with their EHR Encourages utilization of their EHR Increased Clinician Satisfaction with the EHR Source: July 2011 Clinicians Survey N = 1228 Users said that having UpToDate embedded in their EHR 2011 91 % 2011 89 % 2011 40 %

14. Is important to patient care Enhances satisfaction with their EHR Encourages utilization of their EHR Increased Clinician Satisfaction with the EHR Source: July 2015 Clinicians Survey N = 2526 Users said that having UpToDate embedded in their EHR 2015 93 % 2015 91 % 2015 47 %

15. 14 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