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Thursday, February 15, 2007

A Simple Person’s Guide to the Value of Health IT.

A colleague who is preparing university grant applications to fund his planned research in Health IT has recently challenged me to identify what I see as the value that can be derived from the implementation of Health IT. He is concerned that until a case is made that can be understood by laymen (read smart people who just know very little about the specific area) his job in obtaining funds will be harder as will my more general task of trying to sell the proposition to Government and other potential funders of investment in the area.

It considering the answer to the challenge it seems to me the best place to start is to consider what it is we want from an ideal healthcare delivery system. I would suggest the following are at the top of the desiderata:

1. The system should be safe and should not cause any harm either through action or inaction.

2. The system should utilise evidence of treatment efficacy and quality to guide patient care.

3. The system should be as cost- effective and equitable as is reasonably possible.

4. The system should operate as a supportive and interesting environment and be as stress-free as possible workplace.

5. The system should provide a co-ordinated seamless experience in managing a particular episode or care or illness with all those involved having the information they need to do their part without continued reference to the subject of care.

6. The system should, as a result of care delivered and with minimal extra effort, generate the information required to support functions such as academic and clinical research, post marketing surveillance of drug side effects, treatment outcomes, systemic system errors, general health system management and delivery of public health and bio-terrorism services and warnings.

If it is agreed these attributes are about right where the question to be asked is there Health IT in its generic form can make a difference.

Health IT can provide clinical decision support to those making the ‘life and death’ decisions and improve both the consistency and quality of the decision making – reducing errors of all sorts - saving both lives and money.

Appropriate use of Health IT can improve the accuracy of a clinician’s recall of a patient’s important attributes (allergies, current and past illnesses, medicines being used etc), ongoing clinical record keeping and in the process assist in the sharing of information between carers while also making available vital information for use in areas mentioned in point six. This is part of the importance of the electronic health record (EHR).

Health IT can assist in the increasingly overwhelming task of managing clinical knowledge and providing this information to those who need it. Increasingly the stream of information being generated by research and clinical trials is exceeding the capacity of clinicians to absorb the available information and to navigate available knowledge without help.

Health IT, as it has been seen to do in so many other fields of endeavour, can also replace much of the repetitive and drudge activities of the operation and delivery of health services. Service departments (laboratories, pharmacies etc) can be automated to maximise efficiency and quality of service, routine accounting and supply chain management can be optimised, photographic film can be replace by digital imaging improving both ease of use and eliminating film costs etc.

Health IT when combined with appropriate communication technologies can provide the information needed for safe consistent and properly co-ordinated care no matter where the patient is – from the surgery to the hospital to the home.

The combination of EHR technology and its implementation and use by the majority or practitioners, will provide the data-bases required to address the needs of research, management and all the other interests mentioned in point six above.

Of course there are potential risks, barriers and problems that need to be addressed. These include management of the security and privacy of identified clinical information, obtaining the proper levels of investment in appropriate technologies, having adequate trained practitioners to ensure proper system use, the proper allocation of the benefits flowing from Health IT deployment and use between all the stakeholders and having pragmatic standardisation of key areas of the technology to ensure effective system interoperation.

Nevertheless the benefits are demonstrable in all the areas mentioned above, have been proven to be there for the taking at a reasonable level of expenditure. All the risks are manageable and it is essentially just time to get on with it!

David.

6 comments:

Anonymous said...

The list of criteria you have presented are exactly what I am complaining about. They make perfectly good sense to fellow physicians but are gobblegook to the public, bureaucrats and politicians. This list is a catalog of the things physicians want for their own satisfaction (not a sin in itself) but it is not evidence of the way in which Health IT saves lives. The case for investment in Health IT and valuing its contributions needs to be couched in examples of where it has made a difference, eg. where getting access to proper identifcation of a patient's medication has saved them from recieving a lethal dose of another drug. Other touch points in the community are waiting lists - how does Health IT reduce waiting lists and give examples of where it has happened. Get out of the abstract and into the lives of real people - then it will be valued and supported.
Jon Patrick

Aus HIT Man said...

Seems odd that working towards a safe and reliable health system is not a goal the public shares. Every day we hear of accidents and disasters in the health system - and long waiting lists as well. Automate the system and all these these can be dramatically improved.

These issues affect the average citizen every time they touch the health system - and most physicians could not care - they are happy in their ignorance - let's keep the patients in the same pathetic state is what you suggest. This is not abstract at all - being asked your history 20 times in one admission hardly ensures good treatment!

David

Anonymous said...

Dear HIT Man, you're not addressing my point and you are introducing irrelevancies. I didn't say the public doesn't share your goals. I said the public, bureaucrats and politicians don't understnad how those goals will be fulfilled using IT.
If we hear "everyday of accidents and disasters in the health system", we don't hear how IT would have prevented and minimised them and that is a responsibility you have to fulfil.

You have introduced a point I was prepared to scout around - "most physicians could not care" - that would appear to almost certainly true and reinforces my point: there is not enough appreciation of what good Health IT can contribute to the wellbeing of patients.
And, your statements ARE ABSTRACT; they do not specify the cases in which IT provides a benefit just as much as your "being asked your history 20 times in one admission" is high hyperbole.
cheers
jp

Aus HIT Man said...

JP has a problem..that is that not admitting to an understanding the capability of modern Health IT - he is concerned it cannot be justified. It can be!

The public knows the current health system is 'bad for your health' - inconsistent and not evidence based. He knows there is technology to address all this..but its not doable to explain in detail in a 2 page high level summary. Each point of the requirements is demonstrable today and will make a hige difference.

Explaining to non-doctors you stop them giving you the wrong pill and save their life with Health IT is not all that hard. Otherwise a real developed INTERACTIVE EUDCATIONAL discussion is needed.

He should pick his chosen benefit target (of the six)and develop it for the lay public - the overall framework is here I reckon.

David.

ps- the level of complaint about being asked the same details 20 times is true..it happened to me and many complain of such idiocy!

D.

Aus HIT Man said...

JP,

Just to join the dots.

If the question is "Where is the evidence health IT can make a difference in OZ?" - the answer is it has never been tried. Sad but true!

If the question is - "Does the Australian Health System have major problems with doctors killing and injuring people (or not treating properly) through delivery systems that set them up to fail, ignorance of current treatment standards, general incompetence, lack of information and inconsistency of treatment or a bit of all of the above?" the answer is yes.

There is unequivocal evidence from a large range of studies, many mentioned on this blog, that Health IT can make a major difference to this if adopted and used. Pity we have never tried it!

PREVENTABLE medical errors in the US kill out a jumbo jet full of patients a day in the US and at least one jumbo a month here. That's why we need to implement Health IT.

It is the ONLY way to make a big difference in the death rate..

Without technology you are only tinkering at the edges.

David.

Anonymous said...

Hmmmmm - reminds me of when the HealthConnect Project tried to identify evidence of improved patient care outcomes as part of the trials. At least two of the trials focussed on the management of diabetes, but if you measure say, HbAlc levels over time - how can you tell if it is the 'Health IT' which has resulted in an improvement - or the model of shared care - plenty of evidence already that that works! The point is that implementing such models of care is often only feasible if you have a way of sharing information across health settings.

By the way - I know of a hospital system implementation in OZ that had an immediate dramatic effect on the death rate - but then it was discovered that the codes used for 'reason for separation' had been incorrectly migrated from the previous system.....