qi4gp & the quest for wisdom harry pert. the information/knowledge hierarchy
TRANSCRIPT
Origins of the knowledge hierarchyWhere is the Life we have
lost in living?
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in information?
TS Eliot
Choruses from the Rock. 1934
What then is wisdom?
Vision and design: creating a preferred future.
Needs to be collaborative, but could include Patient Centred Professionalism. The best health outcomes, as safely as possible, with minimal waste, consistent with community values.
The health service in New Zealand Every day
55,000 people visit a GP 1,350 people admitted to hospital
Every year 3.38m people visit a GP (80% 1 yr, 90% 2 yrs) 15 -19m consultation 30 - 40m clinical decisions made
Enrolment, NHI, HPI Increases accountability
Observations, questions & success factors “Why general practitioners use computers and hospital
doctors do not” British Medical Journal 2002
Good software, and connectivity (PMS & Healthlink) Culture ‘early adopters’ Business model New support for general practice from the early 90s
Clinical leadership Management support
New tier of support for general practice: a vehicle for clinical governance
GP GP
Local networks
RHA, HFADHB MoH
Management Support• Contracting• Claims processing• IM/IT• Analysis and planning • Practice support
Quality Support• Clinical leaders• Clinical specialists• Peer (cell) group • Quality facilitators• Pharmacy and lab• Immunisation & child health • Education organisers
Ranolf Medical Centre
Date:21st November 2008
Prepared by: Michael Humphrey (Technical Director)
Scott Whitwell (Sales Director)
I.T. Strategy Discussion Paper
Observations, questions & success factors Our experience is consistent with
international literature and evidence.
Dennis Protti BJ Healthcare Computing and Information Management Dec 2003
“Over 150 factors… identified, but only two – top management support and clinician involvement… consistently associated with successful implementation”
“Lack of clinician involvement has been a consistent theme in past failures”
Observations, questions & success factors Funding
Largely self funded No pattern of state funding
Expertise Infrastructure in place Many years of experience ‘the burden of prior innovation’
The major phases of qi4gp
52
Initial Stakeholde
r Engageme
nt
8
Clarify & Develop the Vision
Clarify & Develop the VisionAn Initial PerspectiveAn Initial Perspective Implement the VisionImplement the Vision
Apr 07
The Key Directions Project
Stage 1 Business
Case
Agree Projects /
Partnerships
Broader Stakeholde
r Engageme
nt
1
Draft Discussion Paper
4
Plan Next Steps
3
Final Discussion
Paper
Aug 07 Dates TBC
7
Plan to Implement
6
Final Strategy
Document
Consultation Document
Detailed Requirements / Solution
Stage 2 Business
Case
High-level Requirements / Solution
Current Phase
Implementation
9
Track Progres
s
qi4gp
patient
centred
populationclinical
governance
individual
Information collected
Demographic
Name, Age, Gender, Ethnicities (affiliations)
Address (standards, geocode)NHI
Funding eligibility
Clinical
Prevention, screeningConditions
qi4gp
patient
centred
populationclinical
governance
individual
Long Term Conditions
Proactive Structured
Acute Conditions
Reactive ‘Unstructured’
Relationship remains central
Reactive care ok for acute conditions
More structure needed for long term conditions
Relationship remains central
Reactive care ok for acute conditions
More structure needed for long term conditions
qi4gp
patient
centred
populationclinical
governance
individual
National
Regional
DHB/NGO
Network
Practice
Individual
Population
a group of individuals sharing a particular
characteristiceg
age, gender, ethnicitydomicile, deprivation index
health need
qi4gp
patient
centred
populationclinical
governance
individual
National
Regional
DHB/NGO
Network
Practice
Individual
Activitieseg
children needing immunisationflu vaccination
women needing mammogramscardiovascular risk assessment
new migrants & refugeespatients & diabetes, copd
qi4gp
patient
centred
populationclinical
governance
individual
National
Regional
DHB/NGO
Network
Practice
Individual
opportunity
we could measure & manage:
any health problem access, utilisation & outcome
inequalities
improve the care of the individual and inform the
sector
qi4gp
patient
centred
populationclinical
governance
individual
Increasing role of the patient at the centre of health care (cf the provider and organisations)
For information to follow the patient through the health system
Referrals, status, discharge, shared records, interconnectivity
qi4gp
patient
centred
populationclinical
governance
individualSelf care: trusted information
Access to records,appointments, results etc
Information about providers: services, facilities, performance.
qi4gp
patient
centred
populationclinical
governance
individual
Clinical governance is a system in which NHS organisations are accountable for continuously improving quality of their
services and safeguarding high standards of care by creating an environment in which excellence in clinical care will
flourish
qi4gp
patient
centred
populationclinical
governance
individual
Clinical governance is a system in which NHS organisations are accountable for continuously improving quality of their
services and safeguarding high standards of care by creating an environment in which excellence in clinical care will
flourish
qi4gp
patient
centred
populationclinical
governance
individual
Quality Improvement
Local delivery through networks.Quality cycles
Measure performance, feedback, peer review, intervention & review
Where to from here?
1. We must create “an environment in which excellence in clinical care will flourish”
2. All national GP organisations support this project
3. We want to share this development with you4. Common ground, needs, unifying purpose
The patient safety agenda
US: medical error in US hospitals 98,000 deaths per annum (Save 100k) > MVA, breast cancer and aids combined
Australia: Inappropriate medicine use,80,000 hospital
admissions, cost $350m >550,000 avoidable admissions a year, (9%)
NZ: ?
adverse events in Auckland Hospitals 10% of admissions 1% permanent injury or death, 7 extra bed days.