This blog from the ADHA appeared a few days ago.
Health in an age of information
Thursday, 20 April 2017
"Cause we are living in a material world
And I am a material girl
You know that we are living in a material world
And I am a material girl"[1]
And I am a material girl
You know that we are living in a material world
And I am a material girl"[1]
You know these lyrics. Madonna's single "Material Girl" and its accompanying video were huge hits in 1985, and went on to define much of her career. But was she right? Is she really a material girl? And are we living in a material world? More than 30 years after she sang this song, we find that the world we live in is becoming less and less about material things, and more and more about information.
From the perspective of the national and global economy, information technology is a vast and growing sector that is displacing manufacturing in value and influence. A similar trend is apparent in the economy of our daily lives: financial transactions are routinely conducted electronically, and reliance on the physical tokens of notes and coins starts to seem quaint.
The rising influence of information even shows in our understanding of reality itself. We’ve known for some time that the apparently solid objects of our experience are composed of atoms that consist mostly of space. And as physicists probe ever more deeply, even subatomic particles seem less and less substantial. Some theorists go so far as to propose that this gossamer-thin materiality rests on a bedrock of – you guessed it – information. As the science writer James Gleick puts it:
"The bit is a fundamental particle of a different sort: not just tiny but abstract – a binary digit, a flip-flop, a yes-or-no. It is insubstantial, yet as scientists finally come to understand information, they wonder whether it may be primary: more fundamental than matter itself. They suggest that the bit is the irreducible kernel and that information forms the very core of existence."[2]
Healthcare is no exception to these trends. As treatment methods become more sophisticated, we find that the quality of healthcare is increasingly dependent upon the quality of the information available to practitioners and patients.
It may seem like a truism to say that better health information leads to better healthcare, but in some respects the healthcare profession has been remarkably slow in embracing information technologies. Facsimile machines, for instance, are still in regular use to convey messages between medical practitioners, despite having been phased out in most other sectors. And handwritten notes are still commonplace in both large and small clinical practices.
There are good reasons for this conservatism, starting with the Hippocratic injunction to first, do no harm. Obvious as it is that reliance on facsimile messages and handwritten notes is somewhat old-fashioned, it is not so obvious that they are actively harmful. Newer systems for storing and communicating information may be more efficient and promise greater safety, but that promise ultimately needs to be tested in the crucible of daily practice. In such circumstances, a "devil you know" approach has clear attractions.
Network effects are another inhibiting factor. A single telephone is of no use whatsoever – it becomes useful when there is another telephone that it can call. And it becomes more useful still when there are hundreds or thousands of other telephones. Similar issues arise for other communications and storage technologies: they only become useful when both sender and receiver have similar equipment and apply compatible protocols.
The complexity of healthcare information is yet another factor. The financial sector has readily adopted modern information technologies in part because the key data in that sector is numeric information, which is easily represented and thoroughly standardised. In contrast, the underlying information in healthcare is exceedingly complex: it is often difficult to represent and only loosely standardised.
Despite all this, it has been estimated that adopting modern information technologies to Australia’s healthcare sector will save hundreds of lives and millions of dollars each year[3]. Let’s repeat that: hundreds of lives and millions of dollars could be saved each year by adopting modern information technologies to healthcare.
This represents the challenge, the mission, and the promise of the Australian Digital Health Agency’s work. Improving healthcare information may sound abstract, but this is work with very real, practical outcomes in the material world we live in.
Dr Andrew Westcombe is a technical editor at the Australian Digital Health Agency, with a PhD in Philosophy.
[1] Songwriters: Rans, Robert; Brown, Peter. Material Girl lyrics © Sony/ATV Music Publishing LLC.
[2] Gleick, James, The Information: A History, A Theory, a Flood. Pantheon Books, NY, 2011, pp. 9-10.
[3] See http://www.strategyand.pwc.com/au/home/press/press-releases/displays/48757598
[2] Gleick, James, The Information: A History, A Theory, a Flood. Pantheon Books, NY, 2011, pp. 9-10.
[3] See http://www.strategyand.pwc.com/au/home/press/press-releases/displays/48757598
Here is the link:
I have provided the whole blog so as not to mis-state any of the arguments.
First it is really good to see some sensible points being made on the issues and complexity surrounding digital health.
Second it is really sad to see that the best that can be said on the benefits front is so old.
Booz and Company report identifies possible $7.6 billion in annual savings from Government investment in e-health
Sydney, 6 May 2010 — A report released today by leading global management consultancy, Booz and Company, has revealed Government investment in a comprehensive e-health system may generate more than $7.6 billion in annual healthcare savings by 2020.
The Booz and Company report, Optimising E-Health Value, outlines a comprehensive case for national investment in e-health to better connect GPs, hospitals and other points of care, so as to improve sharing of patient information.
The report points to reduced errors in medication as offering the greatest potential for savings ($2.6 billion), followed by improved care programs and prevention measures ($2.3 billion). Adverse drug events from errors in medication are estimated to affect 10.4% of patients currently treated by GPs in Australia each year, of which half are classified as moderate to severe, 138,000 require hospitalisation, and as many as 18,000 may result in death according
to some sources.
to some sources.
Booz and Company says a comprehensive commitment to e-health could help Australia avoid an estimated 5,000 deaths, two million primary care and outpatient visits, 500,000 emergency department visits and 310,000 hospital admissions each year.
Report co-author and Sydney-based Booz and Company Principal, Klaus Boehncke, said the analysis demonstrated clearly the benefits from significant investment in e-health, and the need to build such investment in the health reform agenda.
“E-health is the crucial missing piece of the health reform jigsaw presently, and it must not be allowed to slip from view,” Mr Boehncke said.
“Indeed, the success of some of the Government’s reforms, particularly the local hospital networks and primary care networks, and reduced Emergency Department waiting times, depends largely on the connectivity that a robust e-health system provides,” he said.
The report was based on Booz and Company’s global experience advising Governments and health authorities in countries overseas including the United States, Canada, Germany, Italy, Singapore, Hong Kong and the UAE. The e-health model outlined in the report draws on Australian health data and has been adjusted to reflect the characteristics of Australia’s health system.
The report says existing e-health investment in Australia has been patchwork, limited and often focused on acute care. It calls for a shift in e-health focus from hospitals to networking primary care settings – GP clinics - where the volume of patient interaction is high and the potential for flow-on benefits are greatest.
“GPs are increasingly at the sharp end of providing integrated and chronic care, and their role becomes more important under the Government’s reforms, with their initial focus on diabetes. There is a real opportunity to reap powerful gains by putting them at the centre of the e-health push,” Mr Boehncke said.
“Australia’s GPs – 95% of whom use computers - are among the most highly computerised in the world. However, they are not well connected with each other, or with other points of care such as hospitals, so the valuable patient information they hold is not shared with other care providers or indeed among their own community,” he said.
“With a national e-health infrastructure in place, we estimate an investment in information networking of $3,000 per annum per GP clinic could deliver up to $668,000 in annual savings per clinic, mainly through prevention and avoidable hospitalisation. Up to $5 billion of the total savings from e-health investment in our model would come from improving connectivity and dissemination of information to and from GPs.”
Booz and Company’s analysis argues the case for Federal and State Governments to fund the information networking of GPs, as they would be the beneficiaries of the resulting savings. The firm estimates Governments would share in 68% ($5.2 billion) of annual savings accruing from a national e-health investment.
Other e-health benefits identified within the Booz & Company report include:
- Better use of healthcare infrastructure
- Less duplication of diagnostics such as lab tests and X-rays
- Savings from optimised use of pharmaceuticals
- Enhanced productivity among healthcare workers
- Early warning from disease outbreaks
Based on current trends, the estimated total annual savings of $7.6 billion from e-health may represent 3% of total health expenditure. This figure does not include flow-on economic benefits to Australia, such as improved workforce productivity, which are estimated to be considerable.
Mr Boehncke said the health community was watching closely for signs from the Federal Government that it would commit to a significant investment in e-health.
“It did seem obvious that e-health would figure prominently in the reform agenda but there are now concerns it may have slipped off the table. That would be disappointing – there are good reasons why comparable countries overseas are investing heavily in this area, and the arguments for doing so here are irresistible,” he said.
Here is the link:
Even if these benefits were real, and I don’t believe the quantum cited for a moment, with the strides in hospital computing, GP computing and secure messaging in the last 6-7 years surely most of them have been captured. Of course the myHR was not even a twinkle in anyone’s eye in 2010, so who knows what impact it may, or may not, have. Of course its costs of the myHR are also not included.
Before more is spent we need current estimates of costs and benefits. I wonder when they might be produced or is the May Budget just to have more evidence free expenditure, or worse, expenditure based on evidence like this. Really if this is the best evidence the ADHA can put forward frankly we are all doomed!
I hope not!
David.