Tranquility Base we have a problem!

Just updated to let people now about an important meeting in Brisbane on Digital Disruption in Health 23 September 2015. Looking forward to hearing all the solutions! Click for details – HISA Qld – Digital disruption and the future of health

Arriving in 2030 and we have a problem!

No it’s not rising sea levels – which will of course be an astronomical challenge with new diseases and the spread of new hosts and vectors and drug resistant infections – sea_levels_rising-300x186 it is the complexity of our eHealth systems around the world. They are now so complex that they are stagnating and costing unimaginable amounts of money and expert resourcing to maintain. Even the experts are moving to more profitable development spaces and the turnover in the industry is impacting on knowledge retention and the ability to maintain legacy systems once integral to digital health facilities.

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There is increasing concern at the steady incidence of adverse occurrences, medication mistakes, genetic splicing errors, privacy and security attacks and a continuing increase in complaints by consumers that their care has become ineffective. Chronic disease sufferers are struggling to understand their personal records and Coroners around the world are criticizing the software giants for decision systems that are out of date, have allowed poor decisions to be made and with rules that do not reflect current evidence for best practice. Governance costs are steadily growing at the expense of direct patient care. We have reached a terminal point. Decisions made, or more correctly not made, have taken us down pathways that are no longer comprehensible.

Previously immensely wealthy developers of health systems are locked in legal conflicts losing millions in settlements and contractual arguments as they find themselves unable to make their systems cope with rapidly emerging demands. Terminologies have become so complex that even small changes bind them into conflicts as decision systems fail abruptly and prevent the upgrading of decision systems. Failed interoperabilty between jurisdictions is causing dissatisfaction with vendors, consumers and regulatory bodies.

Fiction? Yes of course. No one would ever let such important systems get to that point, would they?


Putting the Health back into eHealth

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There has been considerable growth and sophistication in the world of Safety and Quality in Australia and internationally. There are many well documented and specific elements to the safety and quality process such as auditing, standards, guidelines and education plus a steadily increasing commitment of resources and expenditure to ensure the achievement and maintenance of safety in health care. Still far from perfect, significant achievements have been put in place and are making a difference.

A number of hospitals are approaching ‘digital hospital’ status and there is an exponential growth in all manner of health care applications from mobility, advances in telehealth, home monitoring and complex messaging relating to interoperablity between facilities, specialists and primary care services.

It is my belief that eHealth will need an equal or larger commitment to clinical safety into the future. There are many aspects that will need long term management.

These include though not limited to:

  • The clinical safety of applications, system interactions and interfaces
  • The currency of reference terminologies and guidelines
  • Ongoing review and currency of evidence justification for digital clinical pathways, guidelines, rules and templates.
  • Ongoing governance of Clinical Decision Support system rules that are in place or being introduced. Deprecation of rules will also be essential.
  • Essential and innovative auditing processes will need developing to examine and improve the system outputs and inputs including medications, letters, summaries, results, reports etc.
  • Managing clinical aspects of coronial and external investigations of adverse events related to information systems
  • Reporting and KPI analysis for Safety Commissions and facility accreditation, plus inevitable political concerns
  • Ensuring that clinical risk aspects are identified, managed, documented and demonstrated to have been resolved or mitigated for the future.
  • As the Digital Hospital culture grows across the nation, ensuring that appropriate training curricula and updates are managed and in harmony, particularly as clinicians move between different facility based systems
  • Monitoring the safety, messaging content of integrated Point of Care and procedural device safety (e.g. robots, scanners and genomics)
  • Putting in place quality audits of the increased textual components in the various modules and overall professionalism of the clinical content
  • Reviews of the success or failures of the integration aspects in regard to semantic interoperability and data accuracy of the various systems, small and large, local and cloud, fixed and mobile.
  • Ensuring telehealth and remote systems are accurately recording event episodes and that the records are synchronized across aspects such as allergies, alerts, procedures, medication changes etc.
  • Determining and monitoring that the validity of third party (clinical data) is safely integrated and input (i.e. Primary Care, International, Private Sector).
  • In a similar structural way that the clinical Safety and Quality movement has dedicated teams, independent or preferably integrated, with existing structures, I believe this needs to occur within the clinical informatics domain. While both movements need to move in harmony, new sets of skills will be needed along with education, accreditation guides, auditors and a host of research activities. All these functions will need to be networked with a central functioning safety body to ensure consistency and integration as well as leadership, training and career development.

    Then we should all feel safer when the machine asks us how are you feeling today!