Transcript Slide 1

WHEN TWO WORLDS COLLIDE:
BRINGING HEALTH IT & QUALITY IMPROVEMENT TOGETHER
CPSE June 2011
Dr Brian Robson, Medical Director
BRINGING THESE WORLDS TOGETHER
Improvement
Health IT
IMPROVE QUALITY OF HEALTH AND
HEALTHCARE IN THE 21ST CENTURY
THE TWO RONNIES
SOME COWS
COMPUTERS
& HEALTH
USA
Computers are useless.
They can only give you answers
Pablo Picasso
Computers really can improve your health,
or at least make your doctor less likely to kill you.
The Guardian, Jan 2006
Technology in our
lives .....
ADVANCED COMPUTER ASSISTED
HEALTHCARE
CIRCA 1977 !
http://www.amazon.co.uk/Connected-Health-Electronic-TransformDelivery/dp/1118018354/ref=sr_1_1?ie=UTF8&qid=1305492814&sr=8-1
WE LIVE IN EXPONENTIAL TIMES
http://www.youtube.com/watch?v=cL9Wu2kWwSY
WHAT DOES THIS MAKE YOU THINK ?
• Scared ?
• Excited ?
• Bored ?
• Someone else’s job ?
• It’s for the geeks ?
• Nothing to do with healthcare ?
About those cows...
WHY DO THE COWS IN THE ISLE OF
MAN HAVE BETTER COMPUTERS
THAN THE NHS?
Courtesy of Sean Brennan
Data as a byproduct of care
Helps to monitor udder condition – identifies
possible mastitis – sends SMS to farmer !
EVERY COW IS INDIVIDUAL – AND HAS IT’S OWN
RECORD .... BASED ON ITS ‘COW’ NUMBER !
If we can do it for
cows ...
‘QUALITY HEALTHCARE’
?
QUALITY……
http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010
3 QUALITY AMBITIONS
• No avoidable injury or harm from the healthcare they
receive, and that they are cared for in an appropriate, clean
and safe environment at all times.
• The most appropriate treatments, interventions, support
and services will be provided at the right time to everyone
who will benefit, with no wasteful or harmful variation.
• Mutually beneficial partnerships between patients, their
families and those delivering healthcare services.
Partnerships which respect individual needs and values and
which demonstrate compassion, continuity, clear
communication and shared decision-making.
Elec tronic Prescribing and Administration
98,000
Number of patients who die every year in US
hospitals as a result of medical errors
To Err Is Human, Institute of Medicine,2000
To Err Is Human, Institute of Medicine,2000
$38,000,000,000
The financial cost of medical error in the US every year.
To Err Is Human, Institute of Medicine,2000
Number of patients who die every year as a result of
medication errors in hospital
Audit Commission, E&W, 2001
2010 ....
• 120,000+ adverse events /month
• >40% avoidable
• Contributing to ~90,000 deaths/year
• $4,400,000,000 additional CMS costs
http://www.nytimes.com/2010/11/16/business/16medicare.html?_r=2&ref=policy
SYSTEM FAILURES - 2010
• 7 UK NHS organisations
• Failures are common (13-19%)
• Real risk to patients
– 1 in 7 Rx records contained an error. 20% of
which could have resulted in serious harm
– 1 in 7 outpatient appointment proceeded with
incomplete medical record. 1.5% with no record
at all.
• Wide variation in reliability
– 1 in 5 operations involved wrong, faulty or
missing equipment or staff didn’t know where it
was or how to use it.
http://www.health.org.uk/publications/research_reports/evidence_in_brief.html May 2
knowledge ?
GUIDELINES PLAY A VITAL ROLE ...
Average 1.5 million hits / months
INFORMATION OVERLOAD …
But every time I learn
something new, it
pushes something
old out of my brain ....
17 years to apply 14% of research
knowledge to patient care!
Balas EA, Boren SA.
Managing clinical knowledge for health care improvement.
Yrbk of Med Informatics 2000; 65-70
INFORMATION OVERLOAD .....
Trainee in cardiac imaging
• 40 papers a day
• 5 days per week
• 11 years to bring up to speed
• Another 82,000 relevant papers
• 8 years reading
• And that’s only cardiac imaging !
…...... ‘It is impossible to be a specialist’
Strategies for coping with information overload. Smith.R. BMJ 2010; 341:c7126
‘SIGN APPS’
Available free from Apple App Store & Android Stores
Healthcare and IT...
HEALTHCARE AND TECHNOLOGY
“That it will ever come into general use,
notwithstanding its value, is extremely doubtful
because its beneficial application requires much time
and gives a good bit of trouble, both to the patient and
to the practitioner because its hue and character are
foreign and opposed to all our habits and
associations.”
London Times in 1834, describing the stethoscope
ALMOST 10 YEARS AGO !
The committee believes IT must play a central
role in the redesign of the healthcare system if a
substantial improvement in health care quality is
to be achieved during the coming decade”
Crossing the Quality Chasm
2001
‘ Widespread implementation of HIT has been
limited by a lack of generalizable knowledge,
about what types of HIT and implementation
methods will improve care and manage costs
for specific health organizations.’
Costs and Benefits of Health Information Technology
RAND, 2006
“….very limited
rigorous evidence
that these
technologies
actually improve
either the quality or
safety of
healthcare”
• “….despite these substantial gaps in the
evidence-base….. we are cautiously optimistic
that a number of the eHealth applications ….will
result in significant medium to long term
benefits to organisational efficiency and
patient care”
USE OF ELECTRONIC RECORDS IN PRIMARY
CARE ( 2006 / 2009)
Percent
100
98 99
2006
92
97
96
2009
95
89
79
72
75
50
46
42
37
28
25
23
0
NET
NZ
UK
AUS
GER
US
Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
CAN
STATE OF THE NATION
- GENERAL PRACTICE
• 4% full ; 13% partial
• ~ 83% not use EHR
• High satisfaction
• User reported increased quality of care
STATE OF THE NATION
- HOSPITAL
• 1.5% fully
• 7.6% partial
• ~ 90% not use EHR
• 17% prescribing support
$30BN(+) FOR HEALTH IT
IMPROVE THE CARE SYSTEM
THEN ADD IT
“We know that if you try to apply IT to something
that is fundamentally screwed up it doesn’t help
very much!”
Prof. Michael Porter
Harvard Business School
MIT Symposium on Healthcare IT
July 2006
CAUTION
To Err is Human,
…..but to really screw up you need a computer !
Carolyn Clancy, AHRQ
*
ISLANDS OF EXCELLENCE
Courtesy of Dr Carol Peden
The future is already here …
…. it is just not evenly distributed !
William Gibson
THEMATIC ANALYSIS
1.
2.
3.
4.
5.
6.
7.
8.
Making good choices
Best practice implementation
Spread mechanisms
Decision support
Client-Vendor engagement
Engaging patients
Data mining and analysis
Innovation / horizon scanning
TIMES ARE CHANGING
HEALTH AFFAIRS 28, NO. 2 (2009): 361–368; 10.1377⁄HLTHAFF.28.2.361
The Brooklyn based start up offering on-line care backed up by clinic visits and
even home visits !
http://www.youtube.com/watch?v=aGAr281pHHU&feature=player_embedded
CARE WHEN YOU WANT IT, IN A WAY YOU
WANT IT !
… what a pharmacist sees.
57
“Information technology is already the differentiator
between those who are successful and those
who are not ……this will be an even greater
differentiator in the future.”
Roger Hoerl
GE Global Research
“Kaiser Permanente has reached a
strategic decision that Health IT is front
and centre in our business”
Andy Wiesenthal MD
Assoc Exec Dir ,
Kaiser Permenente
Creating Alignment for Health IT
Meaningful
Use
Organization
Desires
Patient
Desires
60
Clinician
Desires
http://www.bellin.org/portal/page/portal/Section
The people in our
region will be the
healthiest in the
nation
Patient desires
“Know me…
Care for me…
Ease my way”
All my information
is available to me
& my caregivers
I consistently
receive the best
known care
IT infrastructure to
achieve a Connected,
Personal Experience
across the Continuum
I am involved
in improving
my health
My time &
resources are
respected
My information
is protected
The people in our
region will be the
healthiest in the
nation
IT infrastructure to
achieve a Connected,
Personal Experience
across the Continuum
Patient desires
Clinician desires
“Know me…
“Respect me…
Care for me…
Ease my way”
Support me…
Make the right thing easy”
All my
information is
available to me
& my caregivers
All the
information I
need is available
to me & my
team
I consistently
receive the best
known care
I consistently
deliver the best
known care
I am involved in
improving my
health
My patients are
engaged in
improving their
health
My time &
resources are
respected
My productivity
is enhanced & I
get home on
time
My information
is protected
The security of
my patients’
information is
never
questioned
BRINGING THESE WORLDS TOGETHER
Improvement
Health IT
IMPROVE QUALITY IN THE 21ST CENTURY
“ I look through a half-opened door into
a future full of interest, intriguing
beyond my power to describe ”
William Mayo
1931
THANK YOU