qi4gp & the quest for wisdom

1. qi4gp & the quest for wisdom Harry Pert

2. The information/knowledge hierarchy

3. Origins of the knowledge hierarchy Where is the Life we have lost in living? Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information? TS Eliot Choruses from the Rock. 1934

4. Russell Ackoff’s path to wisdom

5. What then is wisdom? Vision and design: creating a preferred future. Needs to be collaborative, but could include Patient Centred Professionalism. The best health outcomes, as safely as possible, with minimal waste, consistent with community values.

6. How can general practice help? • Our health service • Our IT platform • Clinical governance

7. The health service in New Zealand • Every day • 55,000 people visit a GP • 1,350 people admitted to hospital • Every year • 3.38m people visit a GP (80% 1 yr, 90% 2 yrs) • 15 -19m consultation • 30 - 40m clinical decisions made • Enrolment, NHI, HPI • Increases accountability

9. Observations, questions & success factors “Why general practitioners use computers and hospital doctors do not” British Medical Journal 2002 Good software, and connectivity (PMS & Healthlink) Culture ‘early adopters’ Business model New support for general practice from the early 90s Clinical leadership Management support

10. RHA, HFA DHB MoH • Management Support • Contracting • Claims processing • IM/IT • Analysis and planning • Practice support • Quality Support • Clinical leaders • Clinical specialists • Peer (cell) group • Quality facilitators • Pharmacy and lab • Immunisation & child health • Education organisers Local networks GP GP New tier of support for general practice: a vehicle for clinical governance

11. Our first IT installation 1989 • Server $13k • 2 terminals $2.5k • Printer $2.8k • Total $30.8k

15. I.T. Strategy Discussion Paper Ranolf Medical Centre Date: 21st November 2008 Prepared by: Michael Humphrey (Technical Director) Scott Whitwell (Sales Director)

16. Observations, questions & success factors Our experience is consistent with international literature and evidence. “Over 150 factors… identified, but only two – top management support and clinician involvement… consistently associated with successful implementation” “Lack of clinician involvement has been a consistent theme in past failures” Dennis ProttiBJ Healthcare Computing and Information Management Dec 2003

17. Observations, questions & success factors Funding Largely self funded No pattern of state funding Expertise Infrastructure in place Many years of experience ‘the burden of prior innovation’

18. An Initial Perspective Clarify & Develop the Vision Implement the Vision • The major phases of qi4gp Apr 07 Aug 07 Dates TBC Current Phase 1 2 3 4 5 6 7 8 9 Broader Stakeholder Engagement Plan to Implement Draft Discussion Paper Initial Stakeholder Engagement Final Discussion Paper Plan Next Steps Final Strategy Document Agree Projects / Partnerships Track Progress The Key Directions Project Consultation Document High-level Requirements / Solution Stage 1 Business Case Detailed Requirements / Solution Stage 2 Business Case Implementation

20. Information collected • Demographic • Name, Age, Gender, • Ethnicities (affiliations) • Address (standards, geocode) • NHI • Funding eligibility • Clinical • Prevention, screening • Conditions

21. Relationship remains central Reactive care ok for acute conditions More structure needed for long term conditions Long Term Conditions Proactive Structured Acute Conditions Reactive ‘Unstructured’

22. National Regional DHB/NGO Network Practice Individual Population a group of individuals sharing a particular characteristic eg age, gender, ethnicity domicile, deprivation index health need

23. National Regional DHB/NGO Network Practice Individual Activities eg children needing immunisation flu vaccination women needing mammograms cardiovascular risk assessment new migrants & refugees patients & diabetes, copd

24. National Regional DHB/NGO Network Practice Individual • opportunity • we could measure & manage: • any health problem • access, utilisation & outcome • inequalities • improve the care of the individual and inform the sector

25. Increasing role of the patient at the centre of health care (cf the provider and organisations) • For information to follow the patient through the health system • Referrals, status, discharge, shared records, interconnectivity

26. Self care: trusted information • Access to records, • appointments, results etc • Information about providers: services, facilities, performance.

27. Clinical governance is a system in which NHS organisations are accountable for continuously improving quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

28. Clinical governance is a system in which NHS organisations are accountable for continuously improving quality of their services and safeguarding high standards of careby creating an environment in which excellence in clinical care will flourish

29. Quality Improvement Local delivery through networks. Quality cycles Measure performance, feedback, peer review, intervention & review

30. Where to from here? • We must create “an environment in which excellence in clinical care will flourish” • All national GP organisations support this project • We want to share this development with you • Common ground, needs, unifying purpose

31. The patient safety agenda • US: medical error in US hospitals • 98,000 deaths per annum (Save 100k) • > MVA, breast cancer and aids combined • Australia: • Inappropriate medicine use,80,000 hospital admissions, cost $350m • >550,000 avoidable admissions a year, (9%) • NZ: • ? • adverse events in Auckland Hospitals • 10% of admissions • 1% permanent injury or death, 7 extra bed days.