1. CPSE June 2011 Dr Brian Robson, Medical Director WHEN TWO WORLDS COLLIDE: BRINGING HEALTH IT & QUALITY IMPROVEMENT TOGETHER

2. BRINGING THESE WORLDS TOGETHER ImprovementHealth IT IMPROVE QUALITY OF HEALTH AND HEALTHCARE IN THE 21 ST CENTURY

3. THE TWO RONNIES SOME COWS COMPUTERS & HEALTH USA

4. Computers are useless. They can only give you answers Pablo Picasso

5. Computers really can improve your health, or at least make your doctor less likely to kill you. The Guardian, Jan 2006

7. Technology in our lives.....

8. ADVANCED COMPUTER ASSISTED HEALTHCARE CIRCA 1977 !

9. http://www.amazon.co.uk/Connected-Health-Electronic-Transform- Delivery/dp/1118018354/ref=sr_1_1?ie=UTF8&qid=1305492814&sr=8-1

10. WE LIVE IN EXPONENTIAL TIMES http://www.youtube.com/watch?v=cL9Wu2kWwSY

12. Scared ? Excited ? Bored ? Someone else’s job ? It’s for the geeks ? Nothing to do with healthcare ? WHAT DOES THIS MAKE YOU THINK ?

13. About those cows...

14. WHY DO THE COWS IN THE ISLE OF MAN HAVE BETTER COMPUTERS THAN THE NHS? Courtesy of Sean Brennan

17. Helps to monitor udder condition – identifies possible mastitis – sends SMS to farmer ! Data as a byproduct of care

18. EVERY COW IS INDIVIDUAL – AND HAS IT’S OWN RECORD.... BASED ON ITS ‘COW’ NUMBER !

19. If we can do it for cows...

20. ‘QUALITY HEALTHCARE’ ?

21. QUALITY…… http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdfhttp://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010

22. 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

25. 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

27. $38,000,000,000 The financial cost of medical error in the US every year. To Err Is Human, Institute of Medicine,2000

28. 1200 Number of patients who die every year as a result of medication errors in hospital Audit Commission, E&W, 2001

29. 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

30. 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.htmlhttp://www.health.org.uk/publications/research_reports/evidence_in_brief.html May 2010

32. knowledge ?

33. GUIDELINES PLAY A VITAL ROLE... Average 1.5 million hits / months

34. INFORMATION OVERLOAD … But every time I learn something new, it pushes something old out of my brain....

35. 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

36. 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

37. ‘SIGN APPS’ Available free from Apple App Store & Android Stores

38. Healthcare and IT...

39. “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

40. 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

41. ‘ 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

42. “….very limited rigorous evidence that these technologies actually improve either the quality or safety of healthcare”

43. “….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”

44. USE OF ELECTRONIC RECORDS IN PRIMARY CARE ( 2006 / 2009) Percent Source: 2006 and 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

45. 4% full ; 13% partial ~ 83% not use EHR High satisfaction User reported increased quality of care STATE OF THE NATION - GENERAL PRACTICE

46. 1.5% fully 7.6% partial ~ 90% not use EHR 17% prescribing support STATE OF THE NATION - HOSPITAL

47. $30BN(+) FOR HEALTH IT

48. 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

49. CAUTION To Err is Human, …..but to really screw up you need a computer ! Carolyn Clancy, AHRQ

50. *

51. ISLANDS OF EXCELLENCE Courtesy of Dr Carol Peden

52. The future is already here … …. it is just not evenly distributed ! William Gibson

53. 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

55. 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

56. CARE WHEN YOU WANT IT, IN A WAY YOU WANT IT !

57. … what a pharmacist sees. 57

58. “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

59. “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

60. Creating Alignment for Health IT 60 Meaningful Use http://www.bellin.org/portal/page/portal/Section

61. 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

62. 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

63. BRINGING THESE WORLDS TOGETHER ImprovementHealth IT IMPROVE QUALITY IN THE 21 ST CENTURY

64. “ I look through a half-opened door into a future full of interest, intriguing beyond my power to describe ” William Mayo 1931

65. THANK YOU