Information Revolution in Health: The Paradox

Starvation in the midst of plenty!

NSW ACHSM Dinner and IBM Executive HealthCare Dinner

Professor Steven C. BoyagesCE Clinical Education and Training Institute

November 2010

Definition

• Paradox-n

• 1. a seemingly absurd or self-contradictory statement that is or may be true: religious truths are often expressed in paradox

• 2. a self-contradictory proposition, such as I always tell lies• 3. a person or thing exhibiting apparently contradictory

characteristics • 4. an opinion that conflicts with common belief

[C16: from Late Latin paradoxum, from Greek paradoxos opposed to existing notions, from para- 1 + doxa opinion]

Challenges to the health system

Rising Demand– Growing & ageing

population

– Chronic illness rising

– High levels smoking, obesity, stress

– High consumer expectations

– High key Worker Expectations

Constrained Capacity

– Patient Safety

– Workforce shortages and

attitudes

– Manage demand within

finite resources

– Cost vs investment

– NSW spends about 28% of

budget on health care

– 1.3 million dollars per hour

3

demography

technology

Needs

“Process changes, like a new computer system or the use of a checklist, may help a bit,” he said, “but if they are not embedded in a system in which the providers are engaged in safety efforts, educated about how to identify safety hazards and fix them, and have a culture of strong communication and teamwork, progress may be painfully slow.”

Investing In Health IT perceived as a

solution to some of these challenges

Benefits

Improved automation

Improved productivity

Reduced duplication

Improved safety

Improved patient and staff

experience

Improved reach of information

and service

Risks

Financial investment not

realised

Poor connectivity

Lack of common standards

Increased risk to patients

Increased staff frustration and

lower morale

Staff expectations not realised

Poor execution and

implementation due to

inadequate training

5

Our Emotive Responses

Why is it so?Have we overestimated the benefits?

Have we underestimated the complexity of the task?

Have we procured the wrong products or systems?

Have we had poor direction?

Have we started at the wrong place?

• Hype

• Failure to understand the complexity of workflow

• Poor Connectedness and Interoperability

• Systems are not yet agile and flexible

• Need for integrated e-government strategy

Gartner

Gartner Hype Cycle

Technology Paradox of Personal Life and WorkComplex Work systems

Spot the Difference

Close to 450 million users sought access to the Internet through mobile devices this year, IDC said. That number could grow as Internet-capable mobile phones, smartphones and other wireless devices become affordable.

The number of mobile Internet users will grow as the number of worldwide Internet users increases. A total of 1.6 billion people accessed the Internet this year, and the number could reach over 2.2 billion users in 2013. More than 1.6 billion devices, including mobile devices, PCs and gaming consoles, were used to access the Internet this year, and that number could top 2.7 billion by 2013.

Disconnect in School

13Slide Courtesy of Cisco, Australia

Improved automation

Improved productivity

Reduced duplication

Improved safety

Improved patient and

staff experience

Improved reach of information

and service

Workflow

Competency and Training

Functionality

Procurement and Implementation

Connectivity Standards

Governance

IT system

Figure 12

Source: The Lancet (DOI:10.1016/S0140-6736(10)61854-5)

Terms and Conditions

•Demography

•Chronic Care

•Equity

•Social Determinants

•Collaboration

•Capital

•Care Models

•Competency

•Culture

Workforce Capacity

DemandNeeds

Technology is the Accelerator

The Fly Wheel of Health

Success Failure