SAFETY in eHEALTH: The power of data and technology to build insight and resilience Neville Board RN, BA, MPH

Information Strategy Manager

SAFETY IN ACTION – SIA National Convention

27 March 2014

Acknowledgements

Dr Niall Johnson, Australian Commission on Safety and Quality in Health Care

A/Prof Christine Jorm, Sydney University

Dr John Wakefield

(then) Executive Director, Queensland Patient Safety Centre

Australian Institue of Health and Welfare (AIHW)

Health expenditure $140.2bn in 2011/12

$5,881 per person ($5711, in NSW to $8,512 in NT)

!   OVERVIEW

Australia’s Health 2012 (AIHW) p.473

Can we measure this?

Thomas EJ, Petersen LA, Measuring errors and adverse event rates in health care, J Gen Intern Med 2003;18:61-67

Device and procedural safety

Medication safety

Safety in eHealth

MULTI-FACETED

P Davies, 2005, Evidence-based Policy at the Cabinet Office, Impact and Insight Seminar, Overseas Development Institute, 17 October 2005, London

Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010

Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010

HUMAN FACTORS

Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010

Human factors engineering (HFE)

Human factors engineering (HFE)

Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010

Human factors engineering (HFE)

Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010

LOW IMPACT

HIGH EFFORT

HIGH IMPACT

LOW EFFORT

X Training Written procedure X

Physical change X X IT system

Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010

Human factors engineering (HFE)

SYSTEMATIC

Systematic monitoring and review of a cohort of procedures/uses with measures of effort, complications, and outcomes allows a genuine safety assessment and generate evidence and lessons on procedure/device efficacy, safety and best-practice implementation.

Application of clinical quality registries

Focus on •  high-cost high-significance procedures •  areas with known variation in outcomes or practice •  economic case for improved outcomes.

Australian examples: •  ANZDATA (renal) •  National Joint Replacement Registry •  ANZICS (intensive care) •  ASCTS (cardiac surgery) •  VSTORM (trauma)

Registries – Example 1 NJRR

Joint replacement •  National Joint Replacement Registry identified

sub-standard prostheses •  Found significant differences in

outcome/need for revision •  Over 4 years the proportion of

hip and knee procedures that are revisions has declined from 14.8 to 11.1% and from 10.4 to 7.9% respectively.

•  These declines are in large part attributable to monitoring systems incorporated into the registry

•  Annual cost saving ~ $44.6 million. The cost of running the Registry is $1.5 million per annum.

Renal transplantation •  Poor outcomes with transplantation lead to increased dialysis •  Cost difference:

Transplantation: $15K p.a.; Dialysis $60K p.a. •  ANZDATA registry has contributed substantially to improved

outcomes of renal transplantation (eg Perit Dial Int, 2007;27(2):184-191)

Registries – Example 2 ANZDATA

Device and procedural safety

Medication safety

Safety in eHealth

coUMADIN   coVERSYL  

cyclosPORIN   cyclosERINE  

DEPO-medrol   SOLU-medrol  

DEPO-medrol   depo-PROVERA*  

solu-CORTEF*   SOLU-medrol  

SCOPING STUDY 2009

Device and procedural safety

Medication safety

Safety in eHealth

Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010

HOW TO SCARE OFF YOUR HOSPITAL MANAGERS

DEATH BY ROI

HOW TO SCARE OFF YOUR “BUSINESS”

DEATH BY PROJECT MANAGEMENT 101

HOW TO SCARE OFF YOUR CLINICAL LEADS

DEATH BY PROJECT LIBRARY

HOW TO SCARE OFF YOUR EXECUTIVE GOVERNANCE

DEATH BY SIGN-OFF

Health Affairs, 30, no.3 (2011):464-471

• choose a system that is intuitive to use and that requires

little training for users

• choose a system that can be modified and developed easily

• ensure that the decision-making process for developing

or selecting a system is participatory, but once this

decision has been taken ensure that implementation is directed

and driven.

These findings need to be tested in other settings to understand

the degree to which they are generalisable.