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Ehealth and improving quality of healthcare
 

Ehealth and improving quality of healthcare

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Healthcare professionals and patients hold fundamentally different views with respect to the content of quality in healthcare as related to the reliability of systems and services. E-Health Systems ...

Healthcare professionals and patients hold fundamentally different views with respect to the content of quality in healthcare as related to the reliability of systems and services. E-Health Systems Quality and Reliability: Models and Standards addresses the reason, principles and functionality of health and health care systems and presents a novel framework for revealing, understanding and implementing appropriate management interventions leading to qualitative improvement. It also provides evidence on the quality and reliability of telemedicine and reviews standards and guidelines for practicing medicine at a distance.

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    Ehealth and improving quality of healthcare Ehealth and improving quality of healthcare Presentation Transcript

    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 11Patient safety andPatient safety and eHealtheHealth::a necessary linka necessary linkYunkap KwankamYunkap KwankamCoordinator, ECoordinator, E--HealthHealthDepartment of Knowledge Management and SharingDepartment of Knowledge Management and SharingItziarItziar LarizgoitiaLarizgoitiaScientist, Quality and Patient SafetyScientist, Quality and Patient SafetyDepartment of Health System Policies and OperationsDepartment of Health System Policies and OperationsBIOMEDEA,BIOMEDEA, Stuttgart, September 23 - 25, 2005
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 22GoalsGoalsTo reflect on the benefits thatTo reflect on the benefits that eHealtheHealth maymaybring to health carebring to health careTo identify some issues that mayTo identify some issues that maycompromise the attainment of suchcompromise the attainment of suchbenefitsbenefitsTo describe the direction of WHO in theTo describe the direction of WHO in thearea ofarea of eHealtheHealth and patient safetyand patient safety
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 33TheThe unsafetyunsafety of health careof health careHealth care interventions are intended to benefitHealth care interventions are intended to benefitpatients, but they can also cause harm.patients, but they can also cause harm.The complex combination of processes,The complex combination of processes,technologies and human interactions thattechnologies and human interactions thatconstitutes the modern health care deliveryconstitutes the modern health care deliverysystem can bring significant benefits.system can bring significant benefits.But it also involves an inevitable risk of adverseBut it also involves an inevitable risk of adverseevents that canevents that can -- and too often do happenand too often do happen
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 44Adverse events in acute hospitalsAdverse events in acute hospitals024681012141618New York Australia Utah andColoradoLondon NewZealandCanada DenmarkIncident rate (per cent)
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 55Where do adverse events occur?Where do adverse events occur?01020304050607080AcutehospitalMentalhealthCommunitynursingLearningdisabilitiesGP OthersSetting of incidents reported to NPSA (2005)
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 66What are they?What are they?0102030405060708090Surgery Dx Therapy Drug Med Fracture Obs Fall Anaesth SystemAE PreventabilityWilson et al.QAHC Study
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 77Why do they occur?Why do they occur?For all clinical categories:For all clinical categories:–– 27% rule based errors27% rule based errors–– 26% skill based errors26% skill based errors–– 25% technical errors25% technical errors–– 16% knowledge based errors16% knowledge based errors–– 7% violations7% violationsReasons for drug related injury:Reasons for drug related injury:–– 18% error in the method of use of dose18% error in the method of use of dose–– 14% drug use inappropriately14% drug use inappropriately–– 12% inadequate monitoring of drug levels12% inadequate monitoring of drug levelsWilson et al,QAHCS
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 88Why do they occur?Why do they occur?Systems errors:Systems errors:–– 25% involved failure to take precautions to25% involved failure to take precautions toprevent accidental injuryprevent accidental injury–– 10% failure to employ indicated tests10% failure to employ indicated tests–– 9% avoidable delay in treatment9% avoidable delay in treatment–– 6% failure to act upon tests results6% failure to act upon tests results–– 6% failure to take adequate history or6% failure to take adequate history orexaminationexamination–– 4% practice outside the area of expertise4% practice outside the area of expertiseWilson et al,QAHCS
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 99Systems propertySystems propertyCurrent conceptual thinking on patientCurrent conceptual thinking on patientsafety places the prime responsibility forsafety places the prime responsibility foradverse events in deficiencies in systemadverse events in deficiencies in systemdesign, organization and operation ratherdesign, organization and operation ratherthan on individual providersthan on individual providers
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1010How canHow can eHealtheHealth contribute?contribute?Improving the effectiveness of careImproving the effectiveness of careReducing harm due to omissions of careReducing harm due to omissions of careReducing occurrence of adverse eventsReducing occurrence of adverse eventsPreventing harm from happening whenPreventing harm from happening whenincidents occurincidents occurLearning from adverse eventsLearning from adverse eventsSimulating best practicesSimulating best practicesSimulating accidentsSimulating accidentsSimulating solutionsSimulating solutions
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1111Potential Impact ofPotential Impact of eHealtheHealthTeleTele--medicine,medicine, teletele--diagnosis,diagnosis, teletele--monitoring,monitoring,teletele--homecare:homecare:Increasing access: reducingIncreasing access: reducingomission of careomission of careIncreasing continuity:Increasing continuity:increasing effectivenessincreasing effectivenessPrompt attention toPrompt attention toemergenciesemergenciesImproving patientImproving patientsatisfactionsatisfactionImproving effectivenessImproving effectiveness
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1212Potential Impact ofPotential Impact of eHealtheHealthEE--billing, ebilling, e--citations, ecitations, e--referral, ereferral, e--administration,administration,smartsmart--cards:cards:Reminders: reducing omissionsReminders: reducing omissionsin processes; crossin processes; cross--checkingcheckingfor accuracy of tests; controllingfor accuracy of tests; controllingfor due medications, crossfor due medications, cross--checking for contraindicationschecking for contraindicationsReducing waitingReducing waiting--times,times,Improving patient satisfactionImproving patient satisfactionReducing costsReducing costs
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1313Potential Impact ofPotential Impact of eHealtheHealthEE--medical records, decisionmedical records, decision--aids, computerized prescribing,aids, computerized prescribing,ee--pharmacypharmacyReducing communication errorsReducing communication errorsReducing medical errorsReducing medical errorsCross checking medical historyCross checking medical historyCross checking therapiesCross checking therapiesBringingBringing--in medical protocolsin medical protocolsBringingBringing--in therapeutic optionsin therapeutic optionsReducing drugReducing drug--interaction errorsinteraction errorsImproving effectivenessImproving effectivenessImproving patient satisfactionImproving patient satisfactionHospital GP office Dx Imaging Pharmacy
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1414Impact ofImpact of eHealtheHealthGovernanceFinancing:ResourcegenerationDeliveryHealth relatedimprovementehealth can intervene at any single function and level ofthe health systemResponsiveness
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1515Impact ofImpact of eHealtheHealthGovernanceFinancing:ResourcegenerationDeliveryHealth relatedimprovementehealth can intervene at any single function and level of thehealth systemResponsivenessE-billingSmart-cardE-insuranceeHealthEducation,Knowledge-sharinge-citations, e-referrals, e-pharmacyTele-medicine,diagnosis,home-careperformancebenchmarking
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1616Another exampleAnother exampleElectronic reporting of adverse incidents, andpatient harm: building knowledge to improvepatient safety
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1717Which are the issues ?Which are the issues ?Provider ICT interface ?Provider ICT interface ?Appropriate use of ICT ?Appropriate use of ICT ?Excessive reliance on ICT?Excessive reliance on ICT?Lack of accessibility?Lack of accessibility?Is the human workforce technically capable ?Is the human workforce technically capable ?KeepingKeeping--up the pace of technologicalup the pace of technologicaldevelopment ? The "olddevelopment ? The "old--technologytechnology--trap"trap"How lessons can be quickly shared ?How lessons can be quickly shared ?
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1818Accent on researchAccent on researchNeed to systematize knowledge on the impact ofNeed to systematize knowledge on the impact ofeHealtheHealth on patient safety, quality, patientson patient safety, quality, patientsperceptions and the cost of health careperceptions and the cost of health careAgreement on an assessment framework:Agreement on an assessment framework:agreement on goals; agreements on casualagreement on goals; agreements on casualpaths and relations across intervening elementspaths and relations across intervening elementsandand eHealtheHealth applicationsapplicationsIoM five main assessment criteria: quality of careIoM five main assessment criteria: quality of careand health outcomes; access to care; healthand health outcomes; access to care; healthcare costs and costcare costs and cost--effectiveness; patienteffectiveness; patientperceptions; clinician perceptionsperceptions; clinician perceptions
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 1919WHOWHO GOeGOeNational and global trends in the use ofNational and global trends in the use ofICT in health services and systems haveICT in health services and systems haveyet to be systematically documented andyet to be systematically documented andanalysed for the benefit of Member Statesanalysed for the benefit of Member StatesWHO has created a Global ObservatoryWHO has created a Global Observatoryforfor eHealtheHealth, dedicated to understanding, dedicated to understandingthethe eHealtheHealth domain: its growth, evolution,domain: its growth, evolution,and impact on health systems in countries.and impact on health systems in countries.
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 2020WHOWHO GOeGOeMission: To improve health by providingMission: To improve health by providingMember States with strategic informationMember States with strategic informationand guidance on best practice, policiesand guidance on best practice, policiesand standards inand standards in eHealtheHealth through athrough anetworked Global Observatory.networked Global Observatory.
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 2121What willWhat will GOeGOe do?do?–– ResearchResearchDevelop a methodology and framework for describingDevelop a methodology and framework for describingeHealtheHealth systemssystemsIdentify indicators to analyseIdentify indicators to analyse eHealtheHealth status in countriesstatus in countriesMonitor theMonitor the eHealtheHealth status and developments in countriesstatus and developments in countries–– PolicyPolicyAnalyse the impact of policy and legislation onAnalyse the impact of policy and legislation on eHealtheHealth–– PublishPublishProduce theProduce the GOeGOe Annual ReportAnnual Report–– ServicesServicesProvideProvide eHealtheHealth tools and servicestools and servicesAdvise countriesAdvise countries
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 222211ststWorld wide SurveyWorld wide SurveyScope:Scope:–– Policies and strategiesPolicies and strategies–– InfrastructureInfrastructure–– ContentContent–– Cultural and linguistic diversityCultural and linguistic diversity–– Knowledge and skillsKnowledge and skills–– Contacts and who is doing whatContacts and who is doing what–– eHealtheHealth systems and toolssystems and toolsDeadline for countries, 15 October 2005Deadline for countries, 15 October 2005Second GOe Survey in selected countrieselected countriesInIn--depth & quantitativedepth & quantitativeBuild on the findings of the first Global SurveyBuild on the findings of the first Global SurveyFocus on district level data collectionFocus on district level data collection
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 2323ConclusionsConclusionsPotential ofPotential of eHealtheHealth is substantialis substantialeHealtheHealth by itself is not a response to patientsby itself is not a response to patientsneedsneedsThe rightThe right eHealtheHealth improves quality, effectiveness,improves quality, effectiveness,safety, cost and empowers users.safety, cost and empowers users.To identify best practices in the use of eHealthTo identify best practices in the use of eHealthTo quickly learn and facilitate exchangesTo quickly learn and facilitate exchangesTo build the capacity for the effective use ofTo build the capacity for the effective use ofeHealtheHealth
    • Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 2424Further contactFurther contactWorld Alliance for Patient SafetyWorld Alliance for Patient Safety–– www.who.int/patientsafety/enwww.who.int/patientsafety/enGlobal Observatory onGlobal Observatory on eHealtheHealth::–– Yunkap KwankamYunkap Kwankam kwankamy@who.intkwankamy@who.int