Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Monday, July 21, 2008

The Most Important Report on e-Health and Quality and Safety for 2008.

The following report was released a few weeks ago.

The Impact of eHealth on the Quality & Safety of Healthcare

Friday, 27 June 2008

A Systemic Overview & Synthesis of the Literature Report for the NHS Connecting for Health Evaluation Programme

Josip Car, Ashly Black, Chantelle Anandan, Kathrin Cresswell, Claudia Pagliari, Brian McKinstry, Rob Procter, Azeem Majeed and Aziz Sheikh

- There have been substantial developments in information technology hardware and software capabilities over recent decades and there is now considerable potential to apply these technological developments in relation to aspects of healthcare provision.

- Of particular international interest is the deployment of eHealth applications - that is the use of information technology in healthcare contexts - with a view to improving the quality, safety and efficiency of healthcare.

- Whilst these eHealth technologies have considerable potential to aid professionals in delivering healthcare, the use of these new technologies may also introduce significant new unanticipated risks to patients.

- Also of concern is that even when high quality interventions are developed, they frequently fail to live up to their potential when deployed in the "real world"; a major factor contributing to this paradox is professional resistance to the introduction and use of poorly designed applications.

- Given that the NHS is now committed to the largest eHealth-based modernisation programme in the world, it is appropriate and timely to critically review the international eHealth literature with a view to identifying lessons that can usefully be learnt with respect to the future development, design, deployment and evaluation of eHealth applications.

Download The Impact of eHealth on the Quality & Safety of Healthcare (.pdf, 7.220 KB).

More here:


A useful presentation is also available here.


This is one of those reports that simply has to be read to be appreciated – at the very least the introductory 28 pages are vital and must not be missed by anyone interested in where e-Health is at present and where it probably needs to move.

It is good that those involved are now moving on with the following.

NHS Connecting for Health's NHS Care Record Service Evaluation Begins

Saturday, 12 July 2008

NHS Connecting for Health, the flagship NHS IT programme, is to be evaluated by a national team of researchers led by the University of Edinburgh. The £1.5m study, which begins on 1st September 2008, will run until December 2010 and also involves researchers from the Universities of Nottingham, LSE, School of Pharmacy and the NHS. It will evaluate specifically the adoption of the NHS' Care Record Service which is being implemented in hospitals throughout England.

More here:


The key lesson I take from my reading is that it seems very likely use of Health IT can make a difference to quality and safety of patient care (it is assumed efficiency and care co-ordination is doable and valuable – certainly in countries with high levels of administrative complexity like the USA) but that the hard academic work is yet to be done to prove that is actually the case.

The situation in academic e-Health in Australia is, I fear typical, where both funds and career paths are problematic. Until this is fixed and we can do the trials that are needed to link the use of technology to really improved clinical outcomes in the real world the debate will continue. I wonder will I last long enough to see that happy day?



Teki said...

ACHS is hosting The National Forum on Safety and Quality in Health Care in Adelaide, October.
One of the sessions is “Why do we pay people for their errors?”
In The Age today, Stricter reporting ahead for hospitals.
"At a meeting of federal and state health ministers in Canberra today, federal Health Minister Nicola Roxon will negotiate 40 new hospital and primary care "performance indicators" on which both states and the Commonwealth will have to report as part of the new Australian health care agreements."
It's a known fact of hospital economics that the costs of care after adverse events are reimbursed at rates pegged to the Schedule. In other words, perverse incentives exist. It would be interesting for the public to consider, in detail, the apportioning of costs in the case of, say, a person who has a hip replacement that becomes infected with a multi-resistant bug and then suffers organ failure. Surgeons may tut-tut about the dents in their D and C records, but while they can bill at Medicare Plus rates for the revision surgery, they will not be effectively engaged in prevention.
Will the Health Ministers come out and say their efforts to collect data are hamstrung by the woeful state of health information technology? Or will they dig in and keep defending their own cost over-runs and failed projects.

Teki said...

Three articles on different aspects of health in today's papers serve to put IT under a spotlight. They are -
1. Secret athletes list led to inquiry
"In September last year, ASADA provided Medicare with a list of 878 athletes and 18 support personnel, including doctors, pharmacists, trainers and coaches, and asked that their prescription records for the past five years be cross-referenced with the official list of banned substances."
From an objective viewpoint, and leaving the ethical and privacy issues aside, it would be interesting to know what resources were available, the costs, and the method of audit planned to ensure accuracy and precision of the extracted data.
2. Pharmacists seek expanded powers
"Pharmacists take details of people buying pseudoephedrine products and police are alerted, with the aid of a national database, if suspicious amounts of the drug are bought. Mr Sclavos said the scheme could easily be expanded to include products with high amounts of codeine. This would be preferable to restricting such products to prescription-only, which is being considered. "With this technology that's already existing, we could make sure, for example, that nobody could get another dose of a high-dose codeine product with ibuprofen within 30 days," he said.
What is this technology, and does it integrate with all the other databases that store dynamic health information? What is the status of the Guild's efforts to get monopoly power over prescribing software?
3. Superbugs' wave of destruction all too real
"Despite the issue contributing to poor patient outcomes and threatening to undermine advances in the treatment of infectious diseases, the report said there was no national program to collate data on the prevalence of multi-resistant organisms in Australia."
A key issue in this area is the ability to attach specific microorganisms to specific people. Surveillance must be robust enough to label any contacts of a suspected smallpox, and avoid mistakenly labelling a surgeon as being a blood-borne virus carrier. It's also essential for software to be able to characterise microbes down through a cascade of descriptors. That is, a human has a limited and known number of body parts, but an E.coli will exist in subsets according to the different subtyping systems, and will be variably susceptible to dozens of antimicrobials. It would be interesting to hear the designers of existing surveillance software explain the strengths and weaknesses of their systems.