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Central Reach_Stahl

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by

Michael Cameron

on 6 April 2015

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Transcript of Central Reach_Stahl


Collaborative Technologies for the Delivery of Clinical Intelligence and Guided Decision Making




Case Study


15 year-old girl (I will refer to her as Cindy) with Autism Spectrum Disorder
Presents with severe self-injurious behavior, including: (a) biting the tissue inside of her mouth; which has resulted in mouth ulcers, 9 staph infections over the last year, and the loss of a section of her tongue; (b) self-hitting and eye gouging resulting in ongoing tissue damage and discoloration; (3) daily occurrences of self gagging and projectile vomiting; (4) a disrupted sleep/awake cycle (wakes every morning at 2:30 AM); and (5) community exclusion (i.e., she does not attend school and does not go into the community due to use of protective equipment uncontrolled self-injurious behavior)
Cindy is underweight (five feet tall weighing 86 pounds) and has been prescribed the anti-psychotic medication (Risperdal) since she was 5 years-old
The family is now working with their sixth Board Certified Behavior Analyst
Mom stays at home, has gained 25 pounds in the last year, sleeps 4 hours (in her daughter's bedroom) per night, and has been told repeatedly by physicians and medical professionals that "it's just the autism".

Clinical Decision Analysis
Rapid Decision Making
Overcoming poor infrastructures
(siloed services)
Leveraging expertise
(e.g., medical community)
Coping with volatile information dynamics
(e.g., 3 tabs of Advil given every three hours)
Catalyzing information sharing
(e.g., interdisciplinary)
Overcoming mistrust
(e.g., community based psychiatry)
Parsing signal from noise

Reconciling multiple stakeholders
(e.g., child, family, medical professionals)
Delineating boundaries of authority
(e.g., family)
Monitoring and responding to changes in event status

Decision Analysis
Decision analysis begins with formulating the clinical problem using a decision tree. A decision tree is the structure into which data about treatment effectiveness and treatment complications are integrated.

Clinicians must consider multiple perspectives when making a decision about a treatment direction.
Clinical Decision Making: Predictive Models and Optimization
A Concept Proposal
Clinical Decision Making
Am I within my scope of practice?
Do I need an emergency plan?
What assessments?
What interventions?
What evidence-based practices?
What ethical issues?
What other disciplines?
What communication?
What measures (stakeholder)?
The right direction advice?
What family support is needed?
What resources?
What impact on other children?
Can we do this?
What options?
What is the pharmacological history?
What pharmacological intolerances exist?
What pharmacological agent should be used?
Do other interventions reconcile?
What evidence-based practices should be accessed?
Rule in or rule out medical factors
What assessment methods for a non-verbal child?
Risk stratification. What is the risk of suffering a particular condition and need (or lack thereof) for preventive intervention?
Product Line
Opportunity
The mission of ObiGobi is to use collaborative technologies for delivering clinical intelligence and guided guided decision making
There is an opportunity to create knowledge systems based on common problems encountered by clinicians, school systems, and insurance companies
Tripartite Model for Multiple Audiences
Decision analysis is a formal, mathematical approach to analyzing difficult decisions faced by clinical decision makers (
i.e.,
patients, clinicians, insurance companies). At the individual patient level it can be used to decide on appropriate treatment.
At the group level, it can be used to
develop treatment guidelines and
recommendations. Most clinical
decision analyses are based on a
decision tree.

Used in physical therapy
Used in medicine
ObiGobi Knowldge Systems

Decision Trees and Solutions
Linkage to Standards of Care
Linkage to Evidence Based Practices

Pay-Per Use Software (Software as a Service or SaaS)
Usage of the the software through the cloud
Pay a small subscription fee on a per usage basis every time the software is being used

Product Lines
ObiGobi Knowledge Systems
Decision Tress and Solutions
ObiGobi Media Lab (OM Lab)
Registered Behavior Technician Modules
Training modules on diverse topics
ObiGobi Body Health
Self paced program for optimal health
Based on "One Good Day" system
ObiGobi Clinical Advisory

A system used to "alert" clinicians to important regulatory changes or research developments
Summarizes regulatory and research changes
ObiGobi Marketplace
Field Guides
Balanced Scorecards
Templates
Full transcript