CPSE June 2011 Dr Brian Robson, Medical Director
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Transcript of CPSE June 2011 Dr Brian Robson, Medical Director
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CPSE June 2011
Dr Brian Robson, Medical Director
WHEN TWO WORLDS COLLIDE:BRINGING HEALTH IT & QUALITY IMPROVEMENT
TOGETHER
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BRINGING THESE WORLDS TOGETHER
Improvement Health IT
IMPROVE QUALITY OF HEALTH AND HEALTHCARE IN THE 21ST CENTURY
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THE TWO RONNIES
SOME COWS
COMPUTERS& HEALTH
USA
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Computers are useless.
They can only give you answers
Pablo Picasso
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Computers really can improve your health, or at least make your doctor less likely to kill you.
The Guardian, Jan 2006
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Technology in our lives .....
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ADVANCED COMPUTER ASSISTED HEALTHCARE
CIRCA 1977 !
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http://www.amazon.co.uk/Connected-Health-Electronic-Transform-Delivery/dp/1118018354/ref=sr_1_1?ie=UTF8&qid=1305492814&sr=8-1
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WE LIVE IN EXPONENTIAL TIMES
http://www.youtube.com/watch?v=cL9Wu2kWwSY
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• Scared ?
• Excited ?
• Bored ?
• Someone else’s job ?
• It’s for the geeks ?
• Nothing to do with healthcare ?
WHAT DOES THIS MAKE YOU THINK ?
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About those cows...
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WHY DO THE COWS IN THE ISLE OF MAN HAVE BETTER COMPUTERS THAN THE NHS?
Courtesy of Sean Brennan
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Helps to monitor udder condition – identifies possible mastitis – sends SMS to farmer !
Data as a byproduct of care
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EVERY COW IS INDIVIDUAL – AND HAS IT’S OWN RECORD .... BASED ON ITS ‘COW’ NUMBER !
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If we can do it for cows ...
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‘QUALITY HEALTHCARE’
?
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QUALITY……
http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010
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• 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.
3 QUALITY AMBITIONS
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Electronic Prescribing and Administration
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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
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To Err Is Human, Institute of Medicine,2000
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$38,000,000,000The financial cost of medical error in the US every year.
To Err Is Human, Institute of Medicine,2000
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1200
Number of patients who die every year as a result of medication errors in hospital
Audit Commission, E&W, 2001
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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
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• 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.
SYSTEM FAILURES - 2010
http://www.health.org.uk/publications/research_reports/evidence_in_brief.html May 2010
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knowledge ?
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GUIDELINES PLAY A VITAL ROLE ...
Average 1.5 million hits / months
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INFORMATION OVERLOAD …
But every time I learn something new, it pushes something old out of my brain ....
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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
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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
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‘SIGN APPS’
Available free from Apple App Store & Android Stores
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Healthcare and IT...
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“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
HEALTHCARE AND TECHNOLOGY
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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
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‘ 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
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“….very limited rigorous evidence that these technologies actually improve either the quality or safety of healthcare”
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• “….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”
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9892 89
79
42
2823
99 97 96 95
72
4637
0
25
50
75
100
NET NZ UK AUS GER US CAN
2006 2009
USE OF ELECTRONIC RECORDS IN PRIMARY CARE ( 2006 / 2009)
Percent
Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
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• 4% full ; 13% partial
• ~ 83% not use EHR
• High satisfaction
• User reported increased quality of care
STATE OF THE NATION - GENERAL PRACTICE
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• 1.5% fully
• 7.6% partial
• ~ 90% not use EHR
• 17% prescribing support
STATE OF THE NATION - HOSPITAL
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$30BN(+) FOR HEALTH IT
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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
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CAUTION
To Err is Human,
…..but to really screw up you need a computer !
Carolyn Clancy, AHRQ
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*
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ISLANDS OF EXCELLENCE
Courtesy of Dr Carol Peden
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The future is already here …
…. it is just not evenly distributed !
William Gibson
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THEMATIC ANALYSIS
1. Making good choices
2. Best practice implementation
3. Spread mechanisms
4. Decision support
5. Client-Vendor engagement
6. Engaging patients
7. Data mining and analysis
8. Innovation / horizon scanning
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TIMES ARE CHANGING
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
HEALTH AFFAIRS 28, NO. 2 (2009): 361–368; 10.1377⁄HLTHAFF.28.2.361
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CARE WHEN YOU WANT IT, IN A WAY YOU WANT IT !
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… what a pharmacist sees.57
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“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
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“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
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Creating Alignment for Health IT
60
Meaningful Use
http://www.bellin.org/portal/page/portal/Section
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All my information is available to me & my caregivers
I consistently receive the best known
care
I am involved in improving my
health
My information is protected
My time & resources are
respected
“Know me…Care for me…Ease my way”
Patient desires
IT infrastructure to achieve a Connected, Personal Experience across the Continuum
The people in our region will be the healthiest in the
nation
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All my information is
available to me & my caregivers
I consistently receive the best
known care
I am involved in improving my
health
My information is protected
My time & resources are
respected
“Know me…Care for me…Ease my way”
Patient desires
IT infrastructure to achieve a Connected, Personal Experience across the Continuum
The people in our region will be the healthiest in the
nation All the information I
need is available to me & my
team
I consistently deliver the best
known care
My patients are engaged in
improving their health
The security of my patients’
information is never
questioned
My productivity is enhanced & I
get home on time
“Respect me…Support me…
Make the right thing easy”
Clinician desires
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BRINGING THESE WORLDS TOGETHER
Improvement Health IT
IMPROVE QUALITY IN THE 21ST CENTURY
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“ I look through a half-opened door into a future full of interest, intriguing beyond
my power to describe ”William Mayo
1931
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THANK YOU