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When two worlds collide: Bringing Health IT & Quality Improvement together. CPSE June 2011 Dr Brian Robson, Medical Director. Bringing these worlds together. Improvement. Health IT. Improve quality of health and healthcare in the 21 st century. The two ronnies. Some cows. Computers
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When two worlds collide: Bringing Health IT & Quality Improvement together CPSE June 2011 Dr Brian Robson, Medical Director
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
http://www.amazon.co.uk/Connected-Health-Electronic-Transform-Delivery/dp/1118018354/ref=sr_1_1?ie=UTF8&qid=1305492814&sr=8-1http://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
What does this make you think ? • Scared ? • Excited ? • Bored ? • Someone else’s job ? • It’s for the geeks ? • Nothing to do with healthcare ?
Why do the cows in the Isle of Man have better computers than the NHS? Courtesy of Sean Brennan
Data as a byproduct of care Helps to monitor udder condition – identifies possible mastitis – sends SMS to farmer !
Every cow is individual – and has it’s own record .... Based on its ‘COW’ number !
Quality…… http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf Scottish Government, May 2010
3 Quality Ambitions • 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.
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
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
System failures - 2010 • 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. http://www.health.org.uk/publications/research_reports/evidence_in_brief.htmlMay 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
London Times in 1834, describing the stethoscope Healthcare and technology “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.”
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.
State of the Nation - General Practice • 4% full ; 13% partial • ~ 83% not use EHR • High satisfaction • User reported increased quality of care
State of the Nation - Hospital • 1.5% fully • 7.6% partial • ~ 90% not use EHR • 17% prescribing support
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
