Sunday, October 27, 2013

You Really Have To Wonder What The Evidence Is For All This Optimism. I Am Not Sure I Can Find It.

This appeared in the Financial Review a few days ago.

Digitising data will reduce errors in patient care

Joshua Gliddon
With approximately 9.3 per cent of Australia’s gross domestic product spent on healthcare, there is significant scope for improvement in productivity to drive better health outcomes and better care per dollar spent.
One of the biggest challenges facing the health system in Australia is its highly fragmented nature. Funding is decoupled from the provision of care, and outcomes are not always matched with healthcare inputs, notes David Dembo, general manager for GE’s healthcare business.
“The issue is that the left hand does not know what the right hand is doing. In providing care, the GP, the ­pharmacist and the specialist are only partially informed, and this is why errors are made,” he says.
“We spend an incredible amount of money on healthcare, and for that money you could have an incredible healthcare system, but we don’t yet because we ­execute it badly.”
According to Dembo, along with Australian Medical Association president Steve Hambleton, the key to extracting better productivity within the healthcare sector is through digitisation.
The introduction of the $447 million PCEHR (personally controlled electronic healthcare record) in 2012 under the previous Labor government was supposed to go some way towards breaking down the silos that exist in healthcare data, and provide a transparent way for patients and clinicians to interact.
The promise of the PCEHR has only been partially realised, however, with some insiders indicating the new Coalition government is going to take a significant look at the system. “The answer to increased productivity is digitisation, which means turning clinical information into information that can be shared,” says Dembo. “At the moment data is still locked up in silos, and the key is to create efficiency through transparency.”
Unlike some players, Dembo is optimistic about the impact the PCEHR can have, because it put in place systems, data standards and signifiers needed to begin breaking down the data silos that exist.
“It created a language where we can share information and enable data ­sharing,” he says. “It is giving people the incentive to share information.”
Sally Glass, founder of e-health consulting company CHIK Services, agrees with Dembo about the need for data ­sharing in order to promote productivity in the sector.
“We’ve been talking about the value of information flows in terms of increasing productivity and improving patient outcomes for years,” notes Glass. “But it’s only in the last couple of years that the technology has caught up with the concepts that were being floated around.”
Glass, along with Dembo and Hambleton, is also optimistic about the potential for big data to improve productivity and outcomes in the sector. “The reality is we have to use it,” she says.
Lots more here:
As I read through the full article what keeps striking me is the absence of evidence that what is presently happening with the PCEHR  is actually making a difference in any positive sense. Given the scale of the investment made - which is probably over a $A1 Billion in the last three years- there really should be clear  cut signs that some return is being achieved on this investment.
Instead what we keep hearing is that everyone is optimistic and enthusiastic - except for those who have looked a little harder and wondered if the emperor is wandering around without his clothes.
Everywhere else in the world there has also been optimism about improvements in the cost of health care and impacts on quality and safety. To my mind we see the level of inflation in healthcare costs march ever upward pretty much everywhere and we see any actual impact on quality and being still being pretty hard to demonstrate.
This report on the UK’s efforts makes really interesting reading in this regard.
All I can say is that in Australia in the last decade huge amounts have been spent with incentives and direct investment but I find a dearth of evidence of impact. If ever we needed a few serious studies to sort out what is working and what is not the time is now! Bland assertions from so-called experts really won’t cut it for too much longer.
Who wants to volunteer?


Terry Hannan said...

David, how many times have we heard this "language"? They see medicine a s business and not the business of clinical medicine. The words have NO mention of "clinical information management" and clinical decision support. When reading these statements it almost finger in the back of the throat inducing vomit! Who listens or reads these materials and does anything about it. The PCEHR is the wrong tool for the tasks at hand. Without trying to be arrogant or "all knowing" I would like to suggest the following article published last week.
Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Intern Med J. 2013;43(10):1155-64. Epub 2013/10/19.

Bernard Robertson-Dunn said...

IMHO, it is not the digitisation of data that will make a difference to health care. What will make a difference is better processes.

Creating a health record is actually relatively easy, although I think that the PCEHR is the wrong model, being a single, centralised, national system. What may well have been better is a distributed, locally focused based system.

If eHealth had been driven by the goal of delivering better ways of achieving health outcomes, then the health record would have been a genuine infrastructure component. As it is, the PCEHR is simply an automated version of what is there already. Without better processes, there will be no improvement in health outcomes.

Andrew McIntyre said...

I am a bit sick of these "Masters of the Universe" trying to tell us whats wrong with healthcare and medical practice. Its the people who practice medicine, or are closely associated with it, who have some hope of improving the system and not drafted expensive consulting firms.

We have seen these masters of the universe spend a Billion dollars for an overall negative effect on eHealth so it must be time to try another tack. DOHA imposed software and standards, drafted by accounting firm consultants behind the scene, are failing and have failed. Rather than prioritize patient access to results surely giving the doctors fast, accurate and flexible access to patient results would help improve outcomes and save money and should be the top priority. This side of eHealth has been basically ignored, when improving it would be cheap in comparison.

Its time to return control of software to the market (With consensus standards compliance being required) as the market is far more capable of trying to find a solution that works. The government should exert a safety focused standards compliance governance layer, but no more. Surely after 10 years and a billion dollars spent the word failure has to come up in discussions with the minister.

Anonymous said...

Industry always talks up opportunities to make money, especially from government. Governments and their minions always proclaim great achievement, for obvious political and career reasons respectively. As a mate - ex-Canberra PS - said to me once: "You have to understand that they are never wrong." The sinister side is they all want a central data pool under public service control, for reasons having nought to do with improved health outcomes. I for one won't participate if PCEHR survives the new government's razor gangs. I'm also sure all sorts of lobbying is going on as we speak, to 'save' the project.