Just finished reading Brendan Drumm’s account of his experience of leading change in Public Health in Ireland – as head of the HSE from 2005 to 2010: ‘The Challenge of Change – Putting Patients before Providers‘.
Interesting book on a number of counts: good discussion of a major change project, public health is of interest to all of us, provides an insight into implementing change in public sector and poses some interesting questions about the role of politics and politicians and their impact on provision of public services.
He is very forthright on a number of points:
- Patients (ie the public) need to demand change
- Practitioners need to lead the change
- Primary care is at the centre of any effective solution
- We do not need more beds
- Rationalisation of A&E services across the country was the only option – backed up by significantly improved ambulance services
- HSE (and therfore the public) was paying too much for drugs
- The revised consultant contract (80/20 split of public/private) work is the way forward
Was somewhat surprised not to see some more coverage of potential role of technology in enabling and sustaining change e.g. potential benefits of electronic patient records.
Clearly be believes that he has mapped out a way forward for public healthcare, that we have made significant progress during the last five years and that if the curent incumbents stay on message we will see real changes and benefits for patients in years to come.
It will be interesting to see how a number of changes play out:
- Ongoing discussions re consultant contracts e.g. reimbursement; changing role in context of 80/20 arrangements
- Further consolidation of A&E facilities across the country
- Further role out of integrated services
- How will the current Minister for Health drive forward the changes?
November 17th, 2011
Barry
Attended the 16th Annual Conference of the Healthcare Informatics Society of Ireland (‘HISI’) today. Excellent keynote from Michael Dowling, President and CEO of the North Shore -LIJ Health System USA.
He made some opening remarks about a number of the key drives for change in the US: consolidation (insurers and providers), budget issues, healthcare reform movement.
WRT to IT he claimed to have seen less progress than he would have expected (given that Healthcare is one of the most technologically advanced industries) – probably because (1) fragmented healthcare industry and (2) lack of great products.
He argues strongly for a subtantial commitment to IT – if providers want to trak outcomes and to manage the continuum of care. He is looking for his investment in IT to generate quality, productivity and efficiency – with better outcomes for the patient.
He had some interesting views on RoI and investment in information technology. Quick RoIs do not occur – and people too often build false expectations. IT will not solve the healthcare cost problems. These are down to technological advancement, democratisation of advertising by pharma, demographics (in 100 years we have added 35 years to the average life), life style/ behaviour (e.g. child obesity). Many of these issues are not being addressed at the right level.
Mr Dowling made a number of other observations:
- need to move from pay for service (ie volume) to pay for value
- IT must be used to connect different providers right across the contuum e.g. hospitasls, socil services, ancillary services
- important to implement systems which do notlock people into doing what they are doing today
Finally Mr Dowling reminded all of us about the risks of losing the human factor though over dependence on technology. He expressed his frustration tihw so much unproductive email (referecing the quote ‘the problem with communication is thinking it has occurred’).
Al in all an excellent key note from a CEO committed to investing in information technology to improve patient outcomes. And a CEO who is very upbeat – in spite of the current economic challenges in all markets.
Returning again to the subject of privacy – this time in the case of healthcare.
Interesting paper produced in the US by the Patient Privacy Rights group – the case for informed consent.
Paper references interesting statistics about the number of patients now demanding privacy – in fact the number of patients avoiding early medical checkups/ treatment because of concerns re privacy/ confidentiality.
The paper pushes a very valid principle – that the medial data about the patient belongs to the patient and not the hospital or clinician. Therefore it is not sufficient to think about patient privacy being addressed by software vendors.
The paper outlines it as follows: It is a mistake to design health IT in a paternalistic manner — assuming a corporation, vendor, provider or government agency knows what is best for each individual patient. Instead, we should build ‘patient-centric’ health IT systems.
The challenges posed are potentially complex – but they need to be addressed. For operators they will require changes in processes and systems. But these changes will be required to meet legal requirements and in order to establish and maintain credibility with patients.
Like many others I struggle to get out and take exercise on a regular basis. I have many false starts (or false dawns). May target to walk four times a week – or run twice a week; generally do well for a week or two, then let it slip (early morning meeting, bad weather, travelling for work, any excuse will do…).
Was thinking about some application which would (1) assist me in tracking my efforts and (2) put me in touch with similar ‘athletes’ or ‘would be athletes’.
And then, via a contact on facebook, I come across dailymile
Have to say – looks like a close fit to what I think I need. Some nice features including (1) setting out routes and measuring them and (2) summary analytics.
Will report back after a few weeks of use of the site – looking to use this social network (connected to facebook and twitter) to assist me in becoming more healthy.
Interesting to read Paul Rellis (CEO Microsoft Ireland) pushing significant amounts of technology in Education and Health as ways to address much of the problems we have.
Would agree 100% with Paul Rellis’s ideas around uses of digital technology. However seems to me risk putting cart before the horse. First we need a clear vision of what we are looking to achieve, then commitment from those in Health & Education to achieve the vision, commitment from the investor (govt.) in terms of any required investment. The technology bit is not actually that hard – using Microsoft technology, other proprietary technology and open source technology – in any, to be agreed, configuration.
But first let’s set vision, get some commitment and manage the change.
Great presentation illustrating the trends in healthcare spending in the US – up to 2007. Includes one slide comparing with a number of other countries – including UK.
Brought to my attention by @endamadden on twitter.
Do we have similar information available for Ireland?
Interesting post on project healthdesign: The Doctor’s Role in a Health 2.0 World.
Describing the patient as the ceo for his own body ie he takes responsibility, while the doctro is described as the consultant – advising the patient, seems like a good model, which reinforces the idea that the patient needs to manage his own lifesytyle, etc.
The other interesting obeservation relates to the general ‘information overload’ being experienced by all of us in all walks of life. It is quite possible that a patient may know a great deal more about his specific condition than the doctor providing the advice. However the doctor hopefully brings a broader picture and understanding. Seems no reason why the patient and doctro should not collaborate in advaincing the situation. Of course this does tend to turn the more traditional doctor/ patient model on its head.
In his post earlier this week Jim McGee gives an insight into the use of social media/ social networking by the Mayo Clinic in the US. Not surpisingly for a distinguished and go ahead operation they make widespread use of blogs, podcasting, twitter, facebook, etc. Would be interested to understand what plans the hospitals (state and private) have to use social media here. What is the attitude of hospital management/ admin, medics, other providers of services and patients? Without doubt the current and emerging technologies provide opportunities for hospitals and medics to interact in deeper and broader ways with their patients and potenial future patients.
