CPSE June 2011

Dr Brian Robson, Medical Director

WHEN TWO WORLDS COLLIDE:BRINGING HEALTH IT & QUALITY IMPROVEMENT

TOGETHER

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-Transform-Delivery/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

• 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……

http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf 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

Electronic 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

$38,000,000,000The 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

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

• 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

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...

“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”

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.

• 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 !

http://www.youtube.com/watch?v=aGAr281pHHU&feature=player_embedded

HEALTH AFFAIRS 28, NO. 2 (2009): 361–368; 10.1377⁄HLTHAFF.28.2.361

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

http://www.bellin.org/portal/page/portal/Section

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

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