Ehealth and improving quality of healthcare

Evidence & Information for PolicyEvidence & Information for Policy-- World Health OrganizationWorld Health Organization 11

Patient safety and Patient safety and eHealtheHealth::a necessary linka necessary link

Yunkap KwankamYunkap KwankamCoordinator, ECoordinator, E--HealthHealth

Department of Knowledge Management and SharingDepartment of Knowledge Management and Sharing

ItziarItziar LarizgoitiaLarizgoitiaScientist, Quality and Patient SafetyScientist, Quality and Patient Safety

Department of Health System Policies and OperationsDepartment of Health System Policies and Operations

BIOMEDEA, BIOMEDEA, Stuttgart, September 23 - 25, 2005


Goals Goals

To reflect on the benefits that To reflect on the benefits that eHealtheHealth may may bring to health care bring to health care

To identify some issues that may To identify some issues that may compromise the attainment of such compromise the attainment of such benefitsbenefits

To describe the direction of WHO in the To describe the direction of WHO in the area of area of eHealtheHealth and patient safetyand patient safety


The The unsafetyunsafety of health careof health care

Health care interventions are intended to benefit Health care interventions are intended to benefit patients, 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 that technologies and human interactions that constitutes the modern health care delivery constitutes the modern health care delivery system can bring significant benefits. system can bring significant benefits.

But it also involves an inevitable risk of adverse But it also involves an inevitable risk of adverse events that can events that can -- and too often do happenand too often do happen


Adverse events in acute hospitalsAdverse events in acute hospitals

0

2

4

6

8

10

12

14

16

18

New York Australia Utah andColorado

London NewZealand

Canada Denmark

Incident rate (per cent)


Where do adverse events occur?Where do adverse events occur?

01020304050607080

Acutehospital

Mentalhealth

Communitynursing

Learningdisabilities

GP Others

Setting of incidents reported to NPSA (2005)


What are they? What are they?

0

10

20

30

40

50

60

70

80

90

Surgery Dx Therapy Drug Med Fracture Obs Fall Anaesth System

AE PreventabilityWilson et al.QAHC Study


Why 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% violations

Reasons 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 levels

Wilson et al,QAHCS


Why do they occur? Why do they occur?

Systems errors: Systems errors: –– 25% involved failure to take precautions to 25% involved failure to take precautions to

prevent 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 or 6% failure to take adequate history or

examinationexamination–– 4% practice outside the area of expertise 4% practice outside the area of expertise

Wilson et al,QAHCS


System's propertySystem's property

Current conceptual thinking on patient Current conceptual thinking on patient safety places the prime responsibility for safety places the prime responsibility for adverse events in deficiencies in system adverse events in deficiencies in system design, organization and operation rather design, organization and operation rather than on individual providers than on individual providers


How can How 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 when Preventing harm from happening when incidents occurincidents occurLearning from adverse events Learning from adverse events Simulating best practicesSimulating best practicesSimulating accidentsSimulating accidentsSimulating solutionsSimulating solutions


Potential Impact of Potential Impact of eHealtheHealthTeleTele--medicine, medicine, teletele--diagnosis, diagnosis, teletele--monitoring, monitoring, teletele--homecare: homecare:

Increasing access: reducing Increasing access: reducing omission of careomission of careIncreasing continuity: Increasing continuity: increasing effectivenessincreasing effectivenessPrompt attention to Prompt attention to

emergenciesemergenciesImproving patient Improving patient satisfactionsatisfactionImproving effectivenessImproving effectiveness

http://www.uclh.org/services/index.shtml


Potential Impact of Potential Impact of eHealtheHealthEE--billing, ebilling, e--citations, ecitations, e--referral, ereferral, e--administration, administration, smartsmart--cards:cards:

Reminders: reducing omissions Reminders: reducing omissions in processes; crossin processes; cross--checking checking for accuracy of tests; controlling for accuracy of tests; controlling for due medications, crossfor due medications, cross--checking for contraindications checking for contraindications Reducing waitingReducing waiting--times, times, Improving patient satisfactionImproving patient satisfactionReducing costsReducing costs


Potential Impact of Potential Impact of eHealtheHealthEE--medical records, decisionmedical records, decision--aids, computerized prescribing, aids, computerized prescribing, ee--pharmacypharmacy

Reducing 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 options

Reducing drugReducing drug--interaction errorsinteraction errorsImproving effectivenessImproving effectivenessImproving patient satisfactionImproving patient satisfactionHospital GP office Dx Imaging Pharmacy


Impact of Impact of eHealtheHealth

Governance

Financing:

Resource generation

DeliveryHealth related improvement

ehealth can intervene at any single function and level of the health system

Responsiveness


Impact of Impact of eHealtheHealth

Governance

Financing:

Resource generation

DeliveryHealth related improvement

ehealth can intervene at any single function and level of thehealth system

ResponsivenessE-billing

Smart-cardE-insurance

eHealth

Education, Knowledge-

sharing

e-citations, e-referrals, e-pharmacy

Tele-medicine, diagnosis, home-care

performance benchmarking


Another exampleAnother exampleElectronic reporting of adverse incidents, and patient harm: building knowledge to improve patient safety


Which 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 technological up the pace of technological development ? The "olddevelopment ? The "old--technologytechnology--trap"trap"How lessons can be quickly shared ? How lessons can be quickly shared ?


Accent on researchAccent on researchNeed to systematize knowledge on the impact of Need to systematize knowledge on the impact of eHealtheHealth on patient safety, quality, patient's on patient safety, quality, patient's perceptions 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 casual agreement on goals; agreements on casual paths and relations across intervening elements paths and relations across intervening elements and and eHealtheHealth applicationsapplicationsIoM five main assessment criteria: quality of care IoM five main assessment criteria: quality of care and health outcomes; access to care; health and health outcomes; access to care; health care costs and costcare costs and cost--effectiveness; patient effectiveness; patient perceptions; clinician perceptionsperceptions; clinician perceptions


WHO WHO GOeGOe

National and global trends in the use of National and global trends in the use of ICT in health services and systems have ICT in health services and systems have yet to be systematically documented and yet to be systematically documented and analysed for the benefit of Member Statesanalysed for the benefit of Member States

WHO has created a Global Observatory WHO has created a Global Observatory for for eHealtheHealth, dedicated to understanding , dedicated to understanding the the eHealtheHealth domain: its growth, evolution, domain: its growth, evolution, and impact on health systems in countries.and impact on health systems in countries.


WHO WHO GOeGOe

Mission: To improve health by providing Mission: To improve health by providing Member States with strategic information Member States with strategic information and guidance on best practice, policies and guidance on best practice, policies and standards in and standards in eHealtheHealth through a through a networked Global Observatory.networked Global Observatory.


What will What will GOeGOe do?do?–– ResearchResearch

Develop a methodology and framework for describing Develop a methodology and framework for describing eHealtheHealth systemssystemsIdentify indicators to analyse Identify indicators to analyse eHealtheHealth status in countriesstatus in countriesMonitor the Monitor the eHealtheHealth status and developments in countriesstatus and developments in countries

–– PolicyPolicyAnalyse the impact of policy and legislation on Analyse the impact of policy and legislation on eHealtheHealth

–– PublishPublishProduce the Produce the GOeGOe Annual ReportAnnual Report

–– ServicesServicesProvide Provide eHealtheHealth tools and servicestools and servicesAdvise countriesAdvise countries


11stst World 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 tools

Deadline for countries, 15 October 2005 Deadline for countries, 15 October 2005 Second GOe Survey in selected countrieselected countries

InIn--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


ConclusionsConclusionsPotential of Potential of eHealtheHealth is substantialis substantialeHealtheHealth by itself is not a response to patient's by itself is not a response to patient's needs needs The right The 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 of To build the capacity for the effective use of eHealth eHealth


Further contactFurther contact

World Alliance for Patient SafetyWorld Alliance for Patient Safety–– www.who.int/patientsafety/enwww.who.int/patientsafety/en

Global Observatory on Global Observatory on eHealtheHealth::–– Yunkap Kwankam Yunkap Kwankam [email protected]@who.int

http://www.who.int/patientsafety/en

mailto:[email protected]

Ehealth and improving quality of healthcare

Health & Medicine