investigating the impact of ehealth on the quality and ...€¦ · quality and safety of health...
TRANSCRIPT
NHS Connecting for Health Evaluation Programme
Investigating the impact of eHealth on the quality and safety of health care:
Systematic literature overview & evidence synthesis
Aziz Sheikh MD, FRCGP, FRCP
eHealth Research Group, Centre for Population Healt h Sciences, The University of Edinburgh
Birmingham, 10 th November 2011
NHS Connecting for Health Evaluation Programme
• Chantelle Anandan
• Kathrin Cresswell
• Akiko Hemmi
• Joe Liu
• Brian McKinstry
• Susannah McLean
• Mome Mukherjee
• Ulugbek Nurmatov
• Claudia Pagliari
• Aziz Sheikh
• Anna Wierzoch
• Ashly Black
• Tomislav Bokun
• Josip Car
• Azeem Majeed
• Yannis Pappas
• Rob Procter
Research team
NHS Connecting for Health Evaluation Programme
Independent Project Steering Committee
•Professor Denis Protti, University of Victoria, Can ada (chair)
•Professor David Bates, Harvard University, USA
•Professor Jeremy Wyatt, University of Warwick, UK
•Dr Maureen Baker, NHS CFH
•Alison Turner, NHS Evidence
•Mr Antony Chutter, RCGP Expert Patient Panel Member
Supporting cast…
NHS Connecting for Health Evaluation Programme
•Professor Richard Lilford (chair)
•Lee Priest
•Jo Foster
•Nathalie Maillard
NHS Connecting for Health Evaluation Programme
• Rationale for eHealth-based transformations of healthcare
• Aims of our evaluation • Methods
• Phase I• Phase II
• Five key contributions• Conclusions• Looking ahead…
Overview
NHS Connecting for Health Evaluation Programme
Spiralling healthcare costs…
NHS Connecting for Health Evaluation Programme
• To produce a systematic overview of the literature examining the effectiveness of eHealth applications to improve the quality and safety of healthcare (Phase I)
• To undertake eHealth focused systematic reviews in strategically important areas (Phase II)
• To deliver a series of eHealth Masterclasses bringing together academics, clinicians, industry representatives and policy makers (Phase II)
Aims
NHS Connecting for Health Evaluation Programme
• Formative work to map and integrate relevant terrains• Systematic overview of the literature focusing on identifying
and reviewing relevant:o Systematic reviews of the literatureo Technical reportso Grey literature
• Systematic reviews undertaken in association with the Cochrane Collaboration and national/international academic collaborators
• Masterclasses on:o Implementation/adoption of electronic health recordso Structuring and coding of electronic health record datao Computerised decision support systemso Telehealthcare-based models of care
Methods
NHS Connecting for Health Evaluation Programme
1. Conceptually mapping the eHealth literature and integrating this with frameworks of quality and safety
5 Main Contributions
MacLean S, et al BMJ 2011
Quality map
EfficiencyStreaming processes
Increasing access (to data)Reducing costs
EquityEnhanced access
Reduced variation
AcceptabilityEnhanced patient satisfaction
communication, empowerment
AccessTo services, knowledge,
data, people, support
EffectivenessClinical appropriateness
(evidence-base + tailoring)Clinical impact
(Derived from multiple sources, e.g. Campbell, Donabedian, Shekelle, Schuster)
NHS Connecting for Health Evaluation Programme
5 Main Contributions
NHS Connecting for Health Evaluation Programme
• The available evidence is of variable quality• Overall, a substantial mismatch between the anticipated/claimed
clinical benefits and those that are currently being demonstrated• The benefits that are being seen relate in the main to shifts in process
measures, with relatively little/disappointing evidence of improvements in clinical endpoints/clinical effectiveness
• These benefits tend to be seen in relation to “home grown” systems, with few evaluations of commercial “off-the-shelf” systems
• Moving forward, there is a need to:o Move from “push” to “pull” based approaches to technology
development/deploymento Recognise the importance of sociotechnical dimensions to aid
adoptiono Understand the importance of time horizonso Think about investments/returns “in the round”, including from
secondary uses of digitial data
Key Findings
“We’ve found is because we’ve got our own system we can develop the system to capture what we need very quickly, it’s quite responsive and that’s kind of put us streets ahead of the other Trusts in that respect. So I think what we’ve decided is we won’t ditch the system it’s actually quite valuable to us, if we bought a ready made system it would be costing us a fortune to have all these amendments made to it.” (Interview 19, Research Nurse, Secondary Care)
Can we speed up and improve returns on investment?
eHealth Research Group, The University of Edinburgh
Can we better align investments and returns?
eHealth Research Group, The University of Edinburgh
NHS Connecting for Health Evaluation Programme
5 Main Contributions
Asthma-specific quality of life
MacLean S, et al Cochrane 2011
Hospitalisations over 12 months
MacLean S, et al Cochrane 2011
t+asthma Abingdon,Oxford
Mobile phone telehealthcare system
Password protected website
NHS Connecting for Health Evaluation Programme
5 Main Contributions
NHS Connecting for Health Evaluation Programme
5 Main Contributions
NHS Connecting for Health Evaluation Programme
• eHealth applications offer considerable potential to develop innovative new approaches to develop care – a key area to focus on is “consumer informatics” as this is potentially low-hanging fruit
• Their benefits should not simply be assumed – rather, these interventions need to be evaluated throughout all stages of the lifecycle
• The importance of secondary uses of coded data to the NHS/academia/UK should not be under-estimated – these benefits tend to accrue as datasets mature over years, if not decades
• We need to create the infrastructure and opportunities to ensure that UK academics remain at the forefront of this rapidly advancing field of enquiry…
Conclusions