UpHill Simulate is a software for clinical training and simulation for physicians, developed by UpHill. It allows physicians to simulate their practice for a given clinical case and receive detailed feedback regarding their actions, according to evidence-based medicine.
The clinical cases are created and owned by healthcare institutions licensed to use the software. Access to the clinical cases is granted by the institution itself.
The landing page:
Once we logged in and have access to one institution page, we see a dashboard of courses available by the institution. A course is a set of learning content and related clinical cases. A course can be about one pathology and might contain one or more clinical cases. In this example, we see one course ongoing about Heart Failure that was started:
Starting a simulation:
Inside the course, we can see the list of content on the left sidebar and which we are currently standing. Once we are ready to start a simulation, preliminary information is given about the scenario of the clinical case.
In this example, the clinical case has already 2 sequential appointments spaced in 14 days and has pre-loaded clinical history and records.
This pre-loaded information is essential and gives us a hint on how the clinical case was built.
Once we are ready, we click on the button Next.
Each simulation starts with a basic appointment record from a physician that references the patient. We need to carefully read these insights to know which action we must make during the stage of the simulation. After reading the record, we start the simulation by clicking on the button Start Simulation:
Resolving the clinical case:
Simulate software tries to recreate the environment of an EHR (Electronic Health Record) program. We can see some patient’s vital signs on the header and the chronology of actions on the left sidebar.
All actions are grouped into four categories:
Records: the physician can register many types of records such as appointments, hospitalization, emergency, admission, or discharge. In this tab, he can also do the physical exams and anamnesis;
Exams: the exams are organized classified into 5 sub-categories that are imagiology, cardiology, laboratory, mutational lab, and others;
Diagnosis: it allows the registration of the correct diagnosis according to the ICD-10-CM catalog.
Plan: in this tab, physicians can prescribe or stop drug usage, require new interventions, appointments, or monitorization considered necessary.
In this example, the clinical case has pre-loaded exams that we can consult in the chronology. We can see the range of reference values, their unit of measure, and the lab results. If the results are red, it means they are outside the reference values.
Note: on the top left, we can always consult available resources provided by the case owners and useful references to help resolve the clinical case.
Creating a Record:
On the Record category, we can do Physical Exams, Anamnesis, and save any type of records necessary for this particular case, by clicking the button New Record. Then, have a list of different types of records and we select the one we search for.
When creating a new type of Record, the physicians have an open text field and there are expected keywords that need to be registered so the action can be considered as fulfilled. These types of records are different from Diagnosis.
Here's an example of an ongoing Physical Exam. We choose with parts of the patient we wish to check and the software replies back with a technical outcome:
Ending the simulation and Feedback page:
After making all necessary actions and appointments for the clinical case, we can end our simulation by pressing the blue button on the top right of the screen. The software automatically guides us to a feedback panel of our score and actions.
We directly see a dashboard of our overall score (do not worry about the score, I'm not a doctor) and how our actions are categorized in various groups such as exams, records, maneuvers, appointments, prescriptions, and questions asked to the patient.
For multi-phase cases such as in this example, we can also have a score regarding each phase:
How is it calculated:
Every case rests in a clinical pathway that describes the best treatment possible according to evidence-based medicine. Therefore, our reference is the clinical pathway itself. If we make the actions listed on the clinical pathway, our score will grow.
The points given for each action are decided by the case creator and owner, the healthcare institution. Therefore, some actions may be more important than others, and also, negative points can be given if we take actions that are considered common mistakes by HCPs. The goal is to change the behavior of our practice so we can perform the best evidence-based medicine.
In "My performance" column, we can see our performance divided into three categories:
Effectiveness: related to all actions listed in the clinical pathway of reference. Give us how much of these actions we have done.
Registry quality: related to all registrations we did and their quality. This often related to some specific keywords that we needed to register during the simulation.
Efficiency: related to the ratio between the necessary and unnecessary actions. An important metric for a value-based healthcare system.
Consulting the supporting evidence:
As we scroll down the page, we have a list of all awaited actions during the simulation. We see that most of the actions have evidence attached to it so we can consult it directly. This is a great case on how scientific articles or other sources are directly applied in medical treatment. To consult the evidence, we only need to click the respective button.
Disagreeing with the score:
Simulate software gives us the chance to disagree with one action by clicking the thumbs down button and to choose one of the available reasons for doing so and the case owner will be notified.
Finally, in some clinical cases, we may want to highlight some actions that are much more important than others in terms of quality treatment to the patient. In this example, we have missed an important action and the software tell us why is it important for the outcome of the patient:
Closing the course:
After we read all the information regarding our performance, we can close the course by clicking on the top-right button. The software will ask us for a quick feedback so the developers can improve the overall experience:
After giving feedback, we end up on the courses dashboard page and we can see the software has marked the course has concluded, although we can redo it again or view the latest results anytime we want!