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Improving Quality And Reducing Cost In Healthcare The Role Of Information And Information Technology - Matthew Swindells
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Improving Quality And Reducing Cost In Healthcare The Role Of Information And Information Technology - Matthew Swindells



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  • JMB comments to RJF: we could remove since we have the picture, but you are right about it not easily changeable given the image and movement, as well as our print timeline…
  • 12-month cumulative cost by Pathway status.
  • Lighthouse improves processes by collecting data as part of the care process. Guide clinical practice with Executable Knowledge and supporting optimal process flows with and clinical decisions with rules and alerts. Ultimately ongoing process improvement is sustained as the collaboration of knowledge and alerts at critical decision point re-enforce the optimal process flows and reporting capabilities track the variations to determine the next potential round of process design changes.
  • Walking is now added to the patient’s Personal Plan for Health
  • Walking is now added to the patient’s Personal Plan for Health


  • 1. Healthcare Informatics Society of Ireland 16 th Annual Conference and Scientific Symposium Improving Quality and Reducing Cost in Health Care The role of information and information technology 16 – 17 November 2011 Professor Matthew Swindells Chair of the British Computer Society, Health Senior Vice President Global Consulting, Cerner Limited Visiting Professor, Surrey University School of Health Management
  • 2. Confront the received wisdom
    • Through the application of information and technology:
    • Reduce cost
    • Improve access
    • Improve quality
    Access Times Cost Quality Failures reduction increase increase Access Times Cost Quality Failures reduction reduce reduce
  • 3. Budget pressures everywhere ... CANADA: From 2012–13 to 2017–18, the Ontario government will attempt to hold health-care spending increases to just 3 per cent per year. Over the last five years, health-care spending has risen by an annual average of 6.5 per cent. (March 2010) German Health Care Spending Cut, Fees Raised (July 2010) DANISH healthcare spending cuts (June 2010) ITALY: EUR24bn Austerity Package Contains Healthcare Spending Cuts (June 2010) SPAIN’s budget for healthcare has been decreased by 2.8 billion euros through a 19 billion dollar austerity plan. (WHO, June 2010) IRELAND: THE HEALTH budget will be cut by €1.4 billion between now and 2014 under the National Recovery Plan. (Nov 2010) ENGLAND: The NHS is expected to make savings of between £15- £20bn over the next 3 years. (Sept 2009)
  • 4. Not just …
  • 5. The cost of technology
  • 6. The cost implications of ageing
    • Dutch study
    • A 90 year old consumes 10x as much healthcare as a 50 year old
    • Cost increases over just 4 years is much greater, the older the age group
    • UK Implications
    • Ageing population
    • Very elderly group growing the fastest
    • 75+ costs 5x as much per annum as a 40 year old
  • 7. How to drive cost reduction Make the institutions more productive Make the system more productive
  • 8. Start by exposing data through portals
  • 9. Rural Hospital Clinic Local Hospital Satellite Campus Pharmacy Rehab Surgery Imaging Center Nursing Home Government Physician Office Laboratory Healthcare System/Hospital (main campus) Then join up the parts of the system
  • 10. Then drive process efficiency Schedule nurse time effectively Automate infusion management Integrated, actionable information availability Managing discharges to reduce readmissions
  • 11. Reducing cost through the use of evidence
  • 12. We know there is a great deal of variation 6 fold variance of your chances of surviving an aneurism across London 4 fold variance of your chances of surviving a stroke across London 10 fold variance of your chances of surviving a heart attack across London Despite 15 years of evidence based standardisation there is still wide variation in outcomes across the NHS Data 2005/06
  • 13. Outcome against cost of intensive care No evidence that shows that spending more creates better outcomes or spending less creates worse Data 2005/06
  • 14. How to address this - the use of evidence Arch Intern Med 1998;158:1665-8 Lancet 1995; 346:407-10 (courtesy Jeff Rose MD, Ascension Health) Strong evidence (RCTs) 57% Practice Based Evidence 27% No substantial evidence 16% (n=150 patients) Evidence-Base for Pneumonia Major therapeutic decision Not a major therapeutic decision Selection of antibiotic FBC on day 3
  • 15.  
  • 16. Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non–Small-Cell Lung Cancer in the Community Setting 12-month cumulative cost by Pathway status. Neubauer M A et al. JOP 2010;6:12-18 ©2010 by American Society of Clinical Oncology
  • 17. Slow Innovation Adoption
    • From time new knowledge discovered until ½ of physicians act on that knowledge = 15 - 17 years
    Everett Rogers, Diffusion of Innovations, 1995 “ Finish medical school and residency knowing everything…read and retain 2 articles every single night…at the end of 1 year you’re only 1,225 years behind.” W Stead. JAMIA 2005;12:113-20 Alper BS, Hand JA, Elliott SG, et al. J Med Lib Assoc 2004;92:429-37 % of population time Adoption Half-life = 17y Knowledge Half-life = 10y Balas, Boren. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000
  • 18. The cost of memory based care Something on the cost to the NHS of drug errors and a drug – drug interaction alert of and/or a closed loop med graphic
    • The adverse drug reactions, which account for some 3% to 5% of all hospital admissions in the UK, cost the NHS in the order of £500 million per year *
    • Hospital errors resulting in preventable adverse drug events occurred most often:
    * Health Select Committee Report, The Influence of the Pharmaceutical Industry, 2005 ** Bates DW, Cullen DJ, Laird N et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention.1995
    • Closed loop medication management
    In Spain each adverse drug reactions, which account 3.47% of big hospital admissions , cost around 3,200€. 34% 4% 56% ** Vitals Lab Rad Electronic Documentation Order Management Pharmacy Management Electronic Medication Administration
  • 19. Technology Enabled Clinical Decision Support Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(7494):765. PMID: 15767266 75% of decision support interventions succeed when the information is provided to clinicians automatically, whereas none succeed when clinicians are required to seek out the advice
    • HCIT evaluation of 167,233 patients at 41 hospitals
    • Clinical decision support associated with:
      • 21% mortality reduction for pneumonia
      • 16% reduction in patient complications
    Potential US Implications: $19 billion savings per year 10,055 lives saved for patients with CAP 25,141 patient complications avoided Amarasingham R, Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009 Jan 26 ;169(2):108-14. PMID: 19171805 Predictors of Success Adjusted OR Automatic provision of decision support as part of workflow 112.1 Provision of decision support at the time and location of decision making 15.4 Provision of recommendation rather than just an assessment 7.1 Computer-based generation of decision support 6.3 Electronic Process Cost Savings Per Patient Decision support $538 Order entry $132 Test results $110 Notes and records – $2
  • 20. Improve care with technology Support decisions with rules and alerts Guide clinical practice with executable knowledge Collect data as part of the care process Imbed real clinical evidence - Sepsis
  • 21. Engaging the patient in managing their own health
  • 22. Engaging the patient in managing their own health David Your blood pressure is a little high. A nurse will call you today.