Dispatches from the hi-blogs.info krew

MIE2009 – Monday morning keynote – Ed Hammond August 31, 2009

The first keynote of the morning here at MIE2009 in Sarajevo is from Ed Hammond on “Realizing the potential of healthcare information technology to enhance global health”. He began by acknowledging that challenges facing Europe also will apply to USA in terms of healthcare , and that sharing experiences are important. In all countries in developed world, cost of healthcare is excessive and rising rapidly – in part, due to technology. How do we justify use of technology if it increases costs of healthcare? Is there evidence that using technology in healthcare saves money? – this is justification often given, but is it true? why do some countries have better health outcomes at half the cost?

Technology should not be the master – but often technology drives what we do – often create solutions and then look for problems – this is not right approach? Outcomes of healthcare do not always match the amount of money. Evidence has NOT shown that increasing amount of money results in better outcomes. Need to spend the money on the right things – need to look at preventive care. Ed stresses he is not anti-technology – but need to use it appropriately. Technology usually does not save money, it costs money – misleads people and can result in problems.

Imaging costs money – but is it always effective to use more images? They can have major impact on quality and effectiveness of care, but may be overdone. With adequate data, we should be able to eliminate errors, and increase amount of knowledge about what works best. Need to improve consistency of care of patients – physicians often influenced by recent outcomes. Geo-coding can be increasingly important in management of disease – why is there geographic disparity in disease incidence and healthcare outcomes? National statistics and population data is important for many countries in managing healthcare – rather than the current strong focus on individuals.

There is trade-off between cost of care and quality of life – often down to individual choice, but needs to be part of the debate. Many of drugs and treatments used are used globally, not just locally – need to aggregate this data to help everyone improve outcomes. Why do some electronic systems mimic paper? – this is limiting on the potential.

What is the purpose of an electronic health record?  Doomed to repeat mistakes if people say ‘that’s not the way we do it’. We often solve the wrong problem in addressing healthcare issues. Need to recognise that query is where value lies, and EHRs need to support queries. patient-centric means one person, one EHR.

EHR so far are a reflection of how data are collected – and we need to move beyond this to proper, comprehensive use of data; needs to be re-usable. Systems need to re-evaluate patient when new data are added to EHR and health IT systems. More data does not mean more information – need intelligent ways to filter data.

Public health has been a neglected component of healthcare in many countries, especially in USA. Needs to be at the forefront of IT use in healthcare. With rare diseases, affecting few people, need to aggregate global data to support clinical trials. Need to strike balance between sharing information for health and needs for privacy etc. Healthcare is a team process – but need to convince the person to engage in health behviour changes.

We need to understand what treatments are effective and what aren’t. We need to convince both patients and providers of the effectiveness or otherwise of high tech and high cost treatments; less costly tests may be better for health in the long run. Should not be rewarding physicians for simply buying systems – should be rewarding them for improving care, and making differences in outcomes. We can have perfect systems, but if they don’t make a difference, what use are they? We can afford failure in small steps if in the long run we make improvements. Need to ‘do once and share’ at global levels to solve problems, and enhance understandings of problems. Need to understand and accommodate different cultures. Need to re-examine and think out of the box; need to push the limits of the technology, so as to level the playing field for all countries. Can we take the best of outcomes from around the world and repeat, from lessons, in other places.

For other reports, see @omowizard and @CiscoGIII tweets.