Exclusive interview: CEO, Clinical Effectiveness, Wolters Kluwer, Health

Dr Denise Basow on how to bridge the communication gap and align care teams across the continuum.

Healthcare systems all over the world are struggling with gaps in communication amongst care teams, which can impact patients’ diagnoses, recovery and care continuity. Hospital Insider sat down with Dr Denise Basow to discuss how hospitals can overcome these challenges, leading to better outcomes for patients. What are the challenges that hospitals in Asia face in ensuring quality of care? The challenges in Asia are really the challenges that healthcare faces all over the world. Some of the factors driving up the cost of care include an ageing population and the increasing prevalence of chronic conditions and diseases. All of this is very expensive for healthcare systems to deal with. We are also seeing a lot of improvement in technology and pharmaceuticals, but the downside of that is that most of the tech and newer drugs are also expensive. What’s more, medicine has become more complicated. When I first joined UpToDate in 1996, one of the things I was frustrated with was that there was just a lot of information to know, but there weren’t good ways of finding that information. Fast forward 20 plus years, and the information has exploded exponentially. If you put all of this together, it is just harder and harder to provide quality healthcare at reasonable cost. This is not only true in Asia, but in most countries around the globe. How can hospitals and healthcare providers address these challenges? Our mission at Wolters Kluwer really aligns with the ‘Triple Aim’ framework (developed by the Institute for Healthcare Improvement); we are trying to improve the quality of care; reduce the cost of care; and improve the patient experience. We do this by providing clinical decision support tools that can help healthcare providers make better evidence-based decisions. We also do this by providing tools that integrate into clinical workflows. We are trying to take aim at reducing medication and diagnostic errors, for instance. Patients are a very important part of this equation; we are working on providing tools that help engage patients in taking ownership of their personal health. One more important component of the solution is that we need to harmonise care across the entire healthcare system. Medicine has become so fragmented that if you have doctors, nurses, pharmacists, patients and everyone else in the healthcare continuum, all making decisions based on disparate information, you simply can't provide high quality or very effective care. [blockquote]Our goal is to align care teams, help them make good decisions and really empower them to change behavior.[/blockquote] Our goal is to align care teams, help them make good decisions and really empower them to change behavior. What will ‘harmonised care’ look like in practice? Let's say a patient comes into the hospital with heart failure, as one example. The hospitalisation starts by a physician writing a set of orders - but that is just one moment in time. Think about all of the decisions that are made from that point forward: how those drugs get administered; the decisions that nurses are making in terms of how often to check up on the patient and what to do in case something goes wrong; up until when a clinician decides when to discharge them. Is everybody aligned with that? And once you discharge the patient, how do we know that they understand their medications and that they can follow through? If all of that decision making isn't aligned, you begin to see conflicts, which lead to inefficiencies, or indecision. Seemingly very small things can end up causing a lot of problems -- and then the patient gets readmitted to the hospital because things don't go well, further driving up costs. We want to provide information that not only helps the physician make good decisions, but also makes sure that the nurses, pharmacists and patients are all aligned with that decision making. We can't solve the problem that the patient has heart failure, but we can certainly try to ensure all those decisions along the way are based on evidence based information. This is information that patients can also act on, and at least help their healing go as smoothly as possible. You mentioned clinical decision support tools that integrate into existing workflows. How does that work? Our solution, UpToDate, has for more than 25 years been about creating a place for a clinician to go when they need an answer to a clinical question. Clinicians have a lot of questions that happen in the everyday care of patients. The real goal of UpToDate was to set about answering those questions. Now, we are focusing on integrating more deeply into the clinicians’ workflow, making it very easy for clinicians to access content at the exact moment they need it. We found that when we can integrate into their workflow, UpToDate use goes up. And when UpToDate use goes up, the data demonstrates that patient outcomes actually get better. Rrecently, we launched UpToDate Advanced. We get more than a million searches a day on UpToDate around the world, which gives us a lot of data to help us understand the challenges and questions that clinicians have. The data shows that there is a lot of variability in care. UptoDate is very good at providing evidence based content in general, and UpToDate Advanced allows the clinician to get down to the patient level. How it works is that we input specific data for that patient and then walk the clinician through an algorithm that helps them get to a good decision about the care for that specific patient. Finally, where would you recommend for lunch in your home city or anywhere in the world? My home city is Boston. We're very well-known for seafood and there's probably twenty or thirty seafood restaurants that would be fantastic places. Dr Denise Basow is the Chief Executive Officer of Clinical Effectiveness, Wolters Kluwer, Health, which develops proven solutions that drive effective decision-making and consistent outcomes across the continuum of care.