Managing information health

Crosslight Management

Royston E Morgan

BHM 303 Managing Information in Health


Module Objectives

to develop an ability to understand and use information as a strategic resource in supporting the delivery of health and social care services.

to provide students with an understanding of the changing role of information and communications technology (ICT) in the light of structural changes in the NHS and social care.

to examine the enabling role of IT in facilitating communication and collaboration among professionals and patients in the health and social care sectors.


Session objectives

Outline the module and rationale

Discuss the use of information as a strategic resource in health

Evaluate the role of information and related systems in health services


Can we distinguish Data Information or Knowledge?

Data as a collection of facts

Information as facts used to plan or to take an action

Knowledge?

Can it be also?

Gossip?

Intuition?

Spreadsheets?

Surveys?

News reports?


Why do we need information?

Advances our understanding of complex situations

Provides warning signs

Reduces uncertainty

Helps us to provide appropriate solutions

Offers historical evidence

Aids communication


Reflect: what is meant when we say data is useful?

Is it

accurate,

reliable,

relevant,

timely,

Accessible,

etc?

Can we discuss

some examples of

when these things

do/don’t happen

and what the impact

is?

Let’s consider different perspectives on

data…


Much of the information managed by professionals is contextualised

In the specific context of use

In the actual case or problem being addressed

The same terms in a different context can carry a different meaning

In the specific mode of practice (can vary across countries for example)

In the use of assumed (implicit) knowledge of the creator and user of the information

Much recorded data by professionals assumes a background knowledge by the reader so that comprehensive exposition is not needed

This can mean the use of the data is local to the situation and it can be difficult to use the same data for other things

By using a constrained (understood) vocabulary

Seen by acronyms or codes which can be very localised


Much of the information needed by IT professionals is specified

Must be as far as possible generic

Covering a broad spectrum of uses

The same terms must be used in the same way (may imply practice change) but …

…Different modes of treatments must be acknowledged

The use of assumed knowledge by users makes ‘its’ use in systems complex

For interpretation or use outside the specific clinical context the assumed knowledge may have to be declared

Data must be comparable across the organisation so that meaningful analysis and comparison can be made (so how and who?)

By using a open (codified) vocabulary

Data elements (codes) are defined in data dictionaries for example to avoid ambiguity

Generic free-text entries are a ‘no-no’ to most IT developments


Much of the information managed by large organisations created at A is needed at B

Health Care workers create and manage information for their use at the point of use

Managing the clinical trajectory through diverse departments (for example using the Patient Record)

To coordinate the professional task…

…and is heavily contextualised and collective

For other consumers of the information

Supplemental data is needed to make ‘it’ understandable and useable

Information can only be added at front end by people who may find no value from doing so

A core issue in managing information in organisations is getting ownership of data


So what do we think is information in Health Care?

Lets first discuss and draw-up a list

in two groups first then plenary.

You are a clinical practitioner or a manager at an acute hospital

What information do you think you might need to manage care?

What information do you think you need to manage the organization?


Benchmarking in the health sector is a structured approach to sharing and comparing practice….

Figures on their own are often not informative

How good or bad are we compared with others?

If others are doing better, can we find out why?

If we are doing really badly relative to others, can we change?

What might inhibit us from improving further?

National standards may seem ‘imposed’ but mostly aim to improve quality


A benchmarking process

1. Agree focus

2. Set baseline

3. Describe best practice

4. Assess current position

5. Compare (and share to reach consensus on target)

6. Determine Action Plan

1. Review and revise

7. Tell ‘everyone’


SCORING A BENCHMARK

WORST BEST

PRACTICE PRACTICE

STEPS TOWARDS

BEST PRACTICE

E D C B A

1 2 3 4 5

Worst

Practice

Best

Practice


But where did the information come from?

Accuracy and precision of data sources?

How up to date is the data?

Are the samples similar to your organisation?

Are different types of organisation benchmarked or is it across the board?

Is there sufficient information about data collection, sampling etc., for you to know?

Are other sources and/or references cited?

Who has assessed data quality?


National Service Frameworks – information only part of the story

Older

People

2001

Older

People

2011 NSF

Expectations

& skills

Public

attitudes

to age

Attitudes to

private care

Medical

Developments

Role of care

professions

Assistive

technologies

Information

through

technology

Government

policies


Is presenting (or collecting) data a neutral act?

Presentation of data is concerned with three parts:

Selection of relevant data

Representation of data

Purpose of presentation


CHD NSF : national service framework for coronary heart disease

Example: CHD NSF information processes

Obligation is for (virtual) registers

established CHD

evidence of non-cardiac arterial disease

Heart failure plus

CHD risk factors

Information Strategy addresses

patients, carers and the public

health professionals delivering care

clinical governance, performance mgt, service planning, public health


Primary Care Trusts (now GP’s I think) and CHD

What information do GP’s need?

What do they need to know about CHD?

From where can they get this information?

How do they know if it is reliable?

http://www.chd.org.uk/intro-nsf-intro.htm

And why is it needed what is the purpose?







Dental Survey Statistics 2007 versus 2006

12% brush 'a few times a week' or 'never'

Only 30% say they brush for two minutes

17% 'can't remember' when they last changed their brush

60% of people would share their brush with their partner, child, friend or favourite celebrity from East Enders

… And13% of respondents from Newcastle

compared to 76% in Nottingham brush for the

2 mins recommended!


And the strange things people floss with:

Drill bit

Saw

Shoelaces

Hammer

Fish bones

Fork

Twig

Safety pin

Toe nails

How should

you interpret

this?


Survey concerns include

Response rates

Sample and respondent bias

Validity

Reliability

Imposing concepts on to the subject

Assumptions around participant interpretation

Their desire to find meaning and either help or outfox the researcher

Scales and measurements

The power of reporting statistics…


Validity in surveys

Construct validity vital (do we really measure what we mean to)

Wording (avoidance of leading, loaded, double-barrelled or confusing questions)

Response bias

Social desirability

Respondent interpretation of questions

‘Face’ Validity also important for responses

Ordering of questions (can randomise with online versions)

Predictive validity – hardly every discussed!


Reliability in surveys

Pilots (with full feedback and modify) are vital

Test-retest (but, time and experience of previous survey may have changed)

Split half (can only be done with some types of instruments).

Internal scales (Cronbach’s alpha) but remember this only means that each scale is measuring a similar thing…


Beware of how data is presented

0

10

20

30

40

50

60

70

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East

West

North


Check the scales etc.

20

25

30

35

40

45

50

55

60

65

70

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East

West

North

What else is wrong with this chart?


Be aware of relevant propositions

Consider the statement ‘Chimpanzee DNA is 99.7% the same as Human DNA’

What does this statement mean what inferences can be drawn?


Be aware of relevant propositions

Do chimpanzees make cars/houses/PCs/ or give lectures in Information Management that are 99.7% as good as those made by humans?

Or…

A lot of DNA is not involved in the development process and this is being included in measurements

Or …

A small change in DNA has a large impact on what is produced


Be very aware of Statements of the form: A is the greatest cause of B

In the UK car crashes are the single greatest cause of deaths among males in their 20s and 30s

This is meaningless as there is no reference with which the scale the statement

The purpose of the statement is to create an atmosphere of severity – and something must be done!

It is at best not justified or at worst incorrect

The Data…


What does the data tell us?

With acknowledgement to Alan McSweeney [email protected]

The underlying life expectancy data shows that young people have very little chance of dying

and death rates are uniformly very low after the first year of life until about age 50.

So a statement such as ‘Car crashes are the greatest cause of deaths among males in their

20s and 30s will inevitably be true because nothing else really kills young males. Death due

to illness is uncommon among this group so any other cause will dominate.


When thinking about how data is presented in the form of statistics

Correlation is not causality

Number of drunks in a town and number of Conservative Party members

Significance tests generally flawed

Look carefully at sampling and method

You will learn much more about this in research methods too – but it is not only about your own research – we are bombarded with statistics these days…critique them carefully and remember our session on risk!

Managing information health

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