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Linked PICO- connecting Systematic reviews, recommendations and patients

How PICOs connect primary studies, systematic reviews and Guidelines
by

Linn Brandt

on 12 September 2014

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Transcript of Linked PICO- connecting Systematic reviews, recommendations and patients

Electronic
medical records and trial registries
Systematic review
Making a
Guideline
Define your clinical questions
Population
Heart attack
Aspirin
Ticagrelor
Death
Heart failure Bleeding
b01a c24
atc
1116632
rxnorm
C503700
MeSH
b01a c06
atc
1191
rxnorm
D001241
MeSH
7947003
snomed-ct
i50.9
ICD-10
A10001
ICPC2
Q000401
MeSH
C16880
NCI
0004352
EFO
155374007
snomed-ct
303123004
snomed-ct
D006333
Q000401
MeSH
MeSH
i21.4
ICD-10
22298006
snomed-ct
D009203
MeSH
You should find the
effect estimates
for every outcome!
(in all PICOs)
P
I
C
O
Heart attack
Aspirin
Ticagrelor
Death
heart failure bleeding
b01a c24
atc
1116632
rxnorm
C503700
MeSH
b01a c06
atc
1191
rxnorm
D001241
MeSH
7947003
snomed-ct
i50.9
ICD-10
A10001
ICPC2
Q000401
MeSH
C16880
NCI
0004352
EFO
155374007
snomed-ct
303123004
snomed-ct
D006333
Q000401
MeSH
MeSH
i21.4
ICD-10
22298006
snomed-ct
D009203
MeSH
All levels of the evidence have PICOs and they build on each other
Many PICOs
Every O's effect estimate is connected to a

Systematic review

or a

Primary Study
One or more PICOs
Every O's effect estimate is connected to many

Primary studies
One PICO
Effect estimates for every O
Primary study
Systematic review
Guideline
PICOs are everywhere
Coded with different ontologies
Which is fine
we can cope
we can link
DATA
PICO
1
PICO
2
PICO
3
PICO
4
chapter 1
chapter 2
PICO
5
PICO
6
PICO
7
PICO
8
PICO
9
PICO
10
chapter 3
chapter 4
chapter 5
chapter 6
PICO
11
PICO
12
PICO
13
PICO
14
PICO
15

PICO
16
PICO
17
PICO
18
PICO
19
PICO
20
PICO
21
PICO
22
PICO
23
PICO
24
PICO
25
PICO
26
PICO
27
PICO
28
PICO
29
you have many PICOs in a guideline
HOW do
we find the right ones?
Systematic review
Systematic review
Systematic review
Systematic review
Systematic review
Systematic review
Systematic review
Attach structured terminology to your PICOs
Connect outcomes to
effect estimates
based on similar PICOs, codes and concepts
for
how is
compared to
looking at these
Intervention
Comparator
Outcomes
using PICO
Systematic review
Systematic review
Having connections in place makes us know more about
what
our pieces of information is about, what is
similar
and what
belongs together
Recommendations
and is used to treat
Patients
Back to guidelines
HOW do we find the right recommendations for our patients?
icpc2
icd-10
openEHR
atc
snomed-ct
Heart attack
We connect patients to
recommendations
based on similar PICOs, codes and concepts
where PICOs end up in
patients today have a lot of terminology attached, from EMRs and clinical systems
One complex P
is there
one guideline that fits the whole of
me?
We need to use multiple recommendations
from multiple guidelines
HOW?
Recommendations must be single entities usable on their own. Guidelines are just containers
Patients do NOT match whole guidelines, they match recommendations
Heart attack
information about patient
observations, labs, previous things
match some recommendations from different guidelines
(containers)
2
4
1
I get a shorter
list of recommendations matching my patient
oh yes, patients are complex
Recommendations made as electronic, single, coded, entities makes them easier to find and
match
with the right patient
it could even be shown in my electronic medical record interface
Can all this really be possible?!?
linkedPICO
www.linkedpico.org
pico1 + pico2 + pico3 -> Recommendation1
pico2 + pico4 -> Recommendation2
effect estimate
effect estimate
effect estimate
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effect estimate
effect estimate
effect estimate
effect estimate
effect estimate
effect estimate
effect estimate
effect estimate
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effect estimate
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effect estimate
effect estimate
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effect estimate
effect estimate
effect estimate
effect estimate
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effect estimate
effect estimate
effect estimate
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effect estimate
effect estimate
effect estimate
Contact us for more information.
We are all about collaboration and working together towards the greater good
Trying to avoid, or improve many O's
By being offered many I and C's
Linked data using PICO

Connecting
systematic reviews recommendations and patients
When
coded PICOS
are present in a Recommendation,
I can link that back to my
patients characteristics
and get useful information and process help
This recommendation
Heart attack
is about
but also about
aspirin and ticarelor
and mentions some useful labs and obersvations
hemoglobin, platelets, INR, creatinin, Troponin T, blood pressure, pulserate
Tell me if patient has had this before
Put this diagnosis in patient condition list
Find all instances of this diagnosis in patients record
Tell me if patient has taken this before, or is taking now
Put this medication on patients medication chart or file a prescription
Find all instances of this drug mentioned in patients record
Get more information about drug from national drug agency
Give me the latest values for my patient
Put all or some of these values in an order form
match patient
Yes
in EMR
This recommendation
Heart attack
is about
but also about
aspirin and ticarelor
match search and knowledge resources
has a PICO that
Tell me when any online textbook updates their heart attack topic and why (maybe I want to do to?)
Tell me if there is a new study matching my PICO that has emerged (I might need to include it)
Show me related evidence (to expore missed, new or interesting things)
Primary studies
Systematic reviews
Guidelines
Textbooks
You have a relationship cascade where evidence is produced......
And used......
Electronic
medical records
And related places where
evidence is used presented and wanted...
Search engines
Decision support
Medical software
Self-help stuff
Order entery
icd-10
snomed-ct
atc
icpc2
rxnorm
loinc
openEHR
rxnorm
snomed-ct
atc
loinc
icd-10
icpc2
openEHR
snomed-ct
snomed-ct
snomed-ct
snomed-ct
icpc2
icd-10
icd-10
atc
rxnorm
mesh
mesh
openEHR
loinc
loinc
Show me related eLearning, patient information, calculators and online health related resources
Cochrane linked data project
When
coded PICOs
are present in a Recommendation,
I can link out to other useful resources to inform readers and authors
Because it is all related
making it
an evidence lifecycle
Sounds interesting?
project
the
Full transcript