Elsevier: Standardising Healthcare Practices via Clinical Decision Support Tools Across 130 Crore Population


Dr Peter Edelstein
Chief Medical Officer, Elsevier

It will take some time with the committed government and physician leadership to get the right infrastructure and ensure cultural & philosophical shift in the way medicine is practiced, shares Dr Peter Edelstein, Chief Medical Officer, Elsevier exclusively with Kusum Kumari & Shivani Srivastava of Elets News Network (ENN)


During this visit to India, what are your key objectives in terms of empowering clinical leaders with knowledge-based systems? Please provide details.

During this trip to India, we want to guide hospitals to learn how to reduce variability through clinical decision support (CDS) solutions. There is a need to know how to uniformly reduce variability not just within the premier institutions, such as All India Institutes of Medical Sciences (AIIMS), but also in the region and in the entire country. CDS solutions empower providers and patients with current and evidence- based guidelines to ensure in the end better patient care. Elsevier supports people to reduce variability through CDS tools. One of the biggest challenges Elsevier witnesses is the misconception that the physicians often have that CDS tools cannot work without electronic medical records (EMRs). EMRs were designed as an efficient system to deliversolutions to medical personnel ranging from nurses, paramedics to doctors. However, even systems that do not have EMRs can also use CDS tools. India as a country is currently at that stage where it needs to develop business strategies to ensure consistent and sustainable care. In order to achieve sustainable care, the medical institutions need to commit to the concept of CDS tools and finances behind it to maximise the benefits for patients and the institution itself. In order to have a current evidence-based guideline, CDS tools need to be rapidly delivered to all kind of patient care and all medical personnel. As India like many countries is witnessing the emergence of new groups of healthcare providers, such as home healthcare experts, pharmacists, etc., Elsevier will play a very crucial role in such a scenario.

In the light of current debatearound the quality of healthcarein India, how far has Elsevier succeeded in integrating its clinical solutions across both public and private institutions? Please provide details.


We actually have these couple of divisions. In the United States (US), I focus mostly on adult practitioners and patients. However, I partner with a team focusing exclusively on students and education because those silos or breaks are artificial. Our company says that listen heres the reality that you may need to learn some different skills when you are training as medical students in terms of population health, cost reduction, etc, but the concepts are now consistent. It does not make sense to not to be teaching our students about what population health is and what CDS is. In fact, in the US, Elseviers nurse educators customers heard some talks they gave and asked Elsevier to author a book for educators about what nursing students need to know abouthealthcare to enable students succeed in their career. Its no different in a country like India. One of the biggest mistakes people make is that they think we are merely talking digital solutions. I believe that knowledge gained from any source should be welcomed. If we dont start with students, they would not succeed in integrating their learning with their practice.

With dramatic changes in healthcare, now medical services are all about improving the health of the population. Therefore, population health management has emerged as a new buzzword across the world, which needs to be understood by everyone, including the practicing doctors. Therefore, we have seen progressive changes in healthcare. Elsevier wants to increase value of healthcare by working together with the institutions, such as AIIMS, and influencing them by exposing them to the changes happening elsewhere. Medical institutions can ensure quality medical care in the remotest corners by working with Elsevier. We must ensure paradigm shift by moving away from reactive acute inpatient care to proactive chronic outpatient maintenance and preventive care. As a responsible healthcare stakeholder, Elsevier is ensuring this paradigm shift. In order to ensure cost-effective quality care and increase patient throughput, we need to control variability. Therefore, Elseviers guidelines and CDS solutions will play crucial role in restraining variability. We will witness better outcomes and reduced costs by reducing variability.

Key Takeaways
  • Litigation increasing worldwide and gaining awareness in India
  • Focus towards patient-centric approach
  • Standardisation of healthcare delivery
  • Strong clinical decision support system, a must
  • Elseviers Orders sets, ClinicalKey, etc. to transform research into patient care

We have designed a range of CDS solutions to enable quality care and efficient delivery of medical services. Our solutions are structured to help your caregivers, professionals and students improve practice, encourage broad and deep adoption of exceptional professional practice guidelines, and promote a culture of quality across ones organisation. Elsevier Order Sets is an innovative, cloud-based solution that enables physicians, clinicians and informaticists to maintain, develop and deploy order sets in a collaborative environment. Order sets ensures consistent delivery of high-quality, cost- effective care.

Which all countries are you focusing on for growing the reach of Elsevier?

We are really excited about emerging markets. We have full-time employees there. Just like we have to look for right institutions here, you cant just go to the biggest opportunities. The healthcare system in China is not ready for some of the changes that India is ready for. The Government of India is already focusing on e-health and digitisation of healthcare services. In terms of markets, India, Australia, Singapore, Thailand, Japan, etc. make sense to me. The Middle East is the biggest emerging market because they have money and they want to be the best healthcare system. In such markets, people are voicing their concerns about change. We see that India is ready for adopting changes. In reality, the Indian economy is one of the most stable economiesas it is not an oil-dependent economy. Additionally, India has a government and leadership committed towards progressive reforms. As of Elsevier, we have a large community that lives here and knows this community very well.

What are your views on the need to have uniform legislations in Indian healthcare system? Please provide details.

Litigation is gaining awareness in India. The change is going to be witnessed 10 years down the line. Credible and critical mass will steer the country towards such a change. The future is not about physicians, but patients who are the customers and the overall healthcare system. We are seeing a paradigm shift. People will not tolerate negligence any longer. One famous case of medical negligence can change the overall situation of healthcare.

What does future of healthcare in India looks like? And, what role will companies like Elsevier play?

We are already investing huge amounts of money in genomics because in another year we will need another set of products. A few years from now antibiotics would not be working for anybody, so we have to have different types of immune therapy. We have to put investment there. The key is that maybe it takes us 10 to 20 years to get the infrastructure everywhere where you think it is important, and then we will always have current, credible and evidence-based content. About 50 years ago, we were not doing what we are doing now and 5 years from now, the scenario will be different. As such, healthcare system is always going to change. Therefore, it will take some time with the committed government and physician leadership to get the right infrastructure and ensure cultural & philosophical shift in the way medicine is practiced. It does not matter how long it takes, what matters is that the entire process of change needs to start.

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