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Evidence-based Healthcare IT


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Malcolm Miller Australia and New Zealand Health Lead

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Evidence-based Healthcare IT

  1. 1. Evidence-based Healthcare IT HINZ 2007 Malcolm Miller Australia and New Zealand Health Lead
  2. 2. Outline <ul><li>An evidence-based approach </li></ul><ul><ul><li>Methodology </li></ul></ul><ul><ul><li>Results </li></ul></ul><ul><ul><li>Discussion </li></ul></ul>
  3. 3. <ul><li>Connectivity within Healthcare is usually in the context of connected infrastructure </li></ul><ul><li>Need to shift paradigm to connecting individuals </li></ul>Methodology
  4. 4. Our Love of Infrastructure
  5. 5. Cloud 9: The Connected Clinican Project IP
  6. 6. Connected Clinicians <ul><li>The Hospital CEO </li></ul><ul><li>The Hospital CFO </li></ul><ul><li>The Hospital CIO </li></ul><ul><li>Director of Intensive Care </li></ul><ul><li>Director of Emergency </li></ul><ul><li>Neuro-Registrar </li></ul><ul><li>Cardiac Physician </li></ul><ul><li>Ward Clerk </li></ul><ul><li>Senior Physician </li></ul><ul><li>Public Relations Staff </li></ul>Technology
  7. 7. The Process Identification of Bottlenecks Observational Research Workshop bottlenecks with Cisco and Intel Review report with clinicians Workshop with all clinicians <ul><li>Overall findings discussed as a group, further exploring the practicality of solutions </li></ul><ul><li>Follow up with clinicians to ensure </li></ul><ul><ul><li>Report factual </li></ul></ul><ul><ul><li>Solutions realistic and practical </li></ul></ul><ul><li>Developed high level solutions for bottlenecks to increase efficiency in information access and communication </li></ul><ul><li>Identified & documented bottlenecks, frustrations and inefficient work processes </li></ul><ul><li>Observed and documented a typical day of six clinicians </li></ul>
  8. 8. Cloud 9 study
  9. 9. Results <ul><li>Children’s Hospital Westmead, Sydney </li></ul><ul><li>340 bed hospital </li></ul><ul><li>3,000 staff </li></ul>Healthy Children for a Healthy Future
  10. 10. A day in the life of a busy clinician Shared frustrations… <ul><li>To varying degrees, clinicians are still struggling with paper-based records and IT systems that fragment knowledge, duplicate information and spend time searching for the information they need to inform good decision making. </li></ul><ul><li>Doctors complain not just of the time it takes for results to come back from the labs or lost images, but of the frustration of trying to track the progress of orders or ready access to a PC to view on line results. </li></ul><ul><li>Communicating with colleagues is frustrating as people try and find the right person with the right piece of advice or information when they need it. </li></ul><ul><li>It all adds up to the same concern – wasting time! </li></ul>
  11. 11. Mobile strategy was born <ul><li>Wireless infrastructure in ED, Surgical Ward, and Operating suite </li></ul><ul><li>Enhance clinician mobility </li></ul><ul><ul><li>COWS </li></ul></ul><ul><li>Facilitate better communication </li></ul><ul><ul><li>Vocera </li></ul></ul>
  12. 12. Waiting times <ul><li>Triage 3 wait times were split into 5 approximate groups </li></ul>
  13. 13. Waiting times with wireless Wireless Infrastructure
  14. 14. Waiting times – continued improvement
  15. 15. Staff time savings <ul><li>Improved time for patients (20 hours/day) = time saved for staff </li></ul><ul><li>Staff asked to self-report the time they had saved with the introduction of the mobile tool </li></ul><ul><li>Range from 0-60 minutes/day </li></ul><ul><ul><li>Consultants (12 minutes/day) </li></ul></ul><ul><ul><li>Fellow (17 minutes/day) </li></ul></ul><ul><ul><li>Nurse (25 minutes/day) </li></ul></ul><ul><ul><li>Registrar (9 minutes/day) </li></ul></ul>
  16. 16. Cost savings <ul><li>Savings of over 20 hours per day or 7,439 hours per year in patient treatment time in the emergency department were observed. </li></ul><ul><li>Potential time savings in clinical treatment time impacted by wireless technology are worth about 122,000 hours or over $7 million per year at 2005/06 prices. </li></ul><ul><li>WCH believes cost saving estimate is conservative given the additional time savings staff may secure as they become more proficient with using the technology. </li></ul>
  17. 17. Economic modelling <ul><li>Based on a 7% discount the NPV for the project based on incremental costs is $33.2 million and the NPV based on total costs is $35 million. </li></ul><ul><li>Even if the NPV is one third of the value concluded by the economic assessment it would still be sufficient to more than twice amortise the cost of the project. </li></ul>“ Accordingly, the economic assessment concludes that the investment by NSW Health in the implementation of wireless technology across all departments in CHW is a worthwhile allocation of funds.” (Applied Economics, June 2006)
  18. 18. UCSF trial <ul><li>UCSF wanted to create a more mobile workflow - piloted mobile clinical assistant </li></ul><ul><li>Structured clinician-centric model to choreograph technology introduction </li></ul><ul><li>Major objectives </li></ul><ul><ul><li>Improve EMR data accuracy and timeliness </li></ul></ul><ul><ul><li>Enhance nursing productivity and workflow </li></ul></ul><ul><ul><li>Improve nursing satisfaction </li></ul></ul><ul><ul><li>Reduce device count in hallways </li></ul></ul><ul><li>Anticipated ROI was enhanced care and patient and clinician satisfaction </li></ul>
  19. 19. Information timeliness
  20. 20. Transcription errors
  21. 21. Clinician satisfaction ratings
  22. 22. Cost of ownership
  23. 23. Discussion Solutions, services and applications for clinicians, healthcare workers and administrators People and process reform including clinical service re-design Pervasive networked ICT on a standardised “medical grade” network infrastructure, including mobility/wireless capability Easier navigation through a simpler “patient journey” to achieve safer, higher quality healthcare outcomes for patients and their families
  24. 24. Discussion cont <ul><li>Controls </li></ul><ul><li>Generalisation to New Zealand sector </li></ul><ul><ul><li>Smaller size of hospitals </li></ul></ul><ul><ul><li>Relative under-investment in Healthcare IT in New Zealand e.g. low wireless penetration </li></ul></ul>
  25. 25. Some key findings <ul><li>Put individuals at the centre of networks of care, information and accountability </li></ul><ul><li>Clinicians are rightly skeptical – but will also evangelise </li></ul><ul><li>Best results come with mix of technology, applications, and process change </li></ul><ul><li>Technology is most effective when it forms part of a larger healthcare reform program in which the use of technology is pervasive, systemic, and sustained </li></ul>.
  26. 26. Questions <ul><li>Malcolm Miller </li></ul><ul><li>[email_address] </li></ul>