Presentation on theme: "CPSE June 2011 Dr Brian Robson, Medical Director WHEN TWO WORLDS COLLIDE: BRINGING HEALTH IT & QUALITY IMPROVEMENT TOGETHER."— Presentation transcript:
CPSE June 2011 Dr Brian Robson, Medical Director WHEN TWO WORLDS COLLIDE: BRINGING HEALTH IT & QUALITY IMPROVEMENT TOGETHER
BRINGING THESE WORLDS TOGETHER ImprovementHealth IT IMPROVE QUALITY OF HEALTH AND HEALTHCARE IN THE 21 ST 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 !
Delivery/dp/ /ref=sr_1_1?ie=UTF8&qid= &sr=8-1
WE LIVE IN EXPONENTIAL TIMES
Scared ? Excited ? Bored ? Someone else’s job ? It’s for the geeks ? Nothing to do with healthcare ? WHAT DOES THIS MAKE YOU THINK ?
About those cows...
WHY DO THE COWS IN THE ISLE OF MAN HAVE BETTER COMPUTERS THAN THE NHS? Courtesy of Sean Brennan
Helps to monitor udder condition – identifies possible mastitis – sends SMS to farmer ! Data as a byproduct of care
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…… Scottish Government, May 2010
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
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
$38,000,000,000 The financial cost of medical error in the US every year. To Err Is Human, Institute of Medicine,2000
1200 Number of patients who die every year as a result of medication errors in hospital Audit Commission, E&W, 2001
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 May 2010
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...
“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
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 Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.
4% full ; 13% partial ~ 83% not use EHR High satisfaction User reported increased quality of care STATE OF THE NATION - GENERAL PRACTICE
1.5% fully 7.6% partial ~ 90% not use EHR 17% prescribing support STATE OF THE NATION - HOSPITAL
$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.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
TIMES ARE CHANGING The Brooklyn based start up offering on-line care backed up by clinic visits and even home visits ! HEALTH AFFAIRS 28, NO. 2 (2009): 361–368; ⁄HLTHAFF
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 60 Meaningful Use
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 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
BRINGING THESE WORLDS TOGETHER ImprovementHealth IT IMPROVE QUALITY IN THE 21 ST CENTURY
“ I look through a half-opened door into a future full of interest, intriguing beyond my power to describe ” William Mayo 1931