Leveraging Assets: Experiences and challenges in ensuring finances, human resources, asset management and legislation enable a functioning health information system at all levels.

Dr Robyn Lawrence

Executive Director

Innovation and Health System Reform

Delivering a Healthy WA

Alternative Title

Outline

• Value of health information• What is needed• Leveraging resources for health information• Leveraging health information to maximise

resource uitilisation• Overcoming the challenges

Value of Health Information

• Health multi-billion dollar business• Financial information alone not sufficient• Require knowledge about:

– the volume of services provided– the outcome of the services– service gaps

• Inform public and government• Plan for the future

Value for Who?

• Patients and carers • Health providers• Health administrators• Researchers• Government

Requirements

• Data Reliability:– Timeliness– Consistency– Standardisation

• Data Integrity• Analysis and interpretation

Human Resources

• Data only as good as the point of entry / collection

• In general people enter much of the data – Variability

• Clear consistency:– Definitions– Process

• Sufficient numbers and skill

Human Resources

• Involving the patient in consent• Data analysis and communication to all

stakeholders• Ensuring appropriate use

– Risk of excessive requirements for inappropriate purposes

• Ensuring appropriate governance– Data custodian process

• Asset management, including ICT support

Asset Management

• Timely data requires input points

• Automation of collection• Forced standardisation of

inputs• Integration of new assets with

data collection systems – data linkage

Legislation

• Required to comply with legislation – both Commonwealth and State / Territory– Varying Acts covering public vs private– Additional legislation also with impact

• Lack of understanding:– Limit appropriate use– Loss of trust of consumers– Loss of trust of providers

• Legislative compliance must be built into systems.

Finances

• Everything has a cost…..– Legislative compliance– Sufficient skilled human resources– Appropriate asset management– Overarching controls

• But, should be able to offset the cost and measure the benefit if we do it right

Why the Challenge

• HR• Assets• Finance• Legislation

• But really:-– Trust– Independence– Alignment of outcomes to provision

The HR Challenge

• Inputs:– Relevance of the information for more than the

immediate task – clinical and non-clinical– Adequate skilled staff numbers

• Output:– Skills to ensure reliable data addressing the issue

• Interpretation and use:– Information can often have multiple interpretations– Frequently source of distrust by all involved

The Asset Challenge

• Supporting infrastructure to collect robust information.

• Value of electronic collection.• Automation probably better than

manual.

The Legislation Challenge

• Too many variables.• Designed to address the “use” issue.• Health care provided in multiple sectors /

providers.• Patients frequently belong to high risk vulnerable

groups.

The Finance Challenge

• Costs• ROI can be difficult to

measure– usually done by surrogate

means, but underpinning success factor may be good health information:

• Access to appropriate information

• Timely access to clinical information which is shared.

Overcoming the Challenge

• Return on investment for all stakeholders.• Identify key drivers of need

– not information for information’s sake

• Even bad data can sometimes bring about change– both in practice and in improving the data quality

• Leadership and commitment to make a difference for the PATIENT and our community

Safety and Quality

• Many key indicators monitored using health information at local level

• VLADs in Queensland• Timely response to clinical practice concerns

Safety and QualityVLAD Plot – Mortality-Acute Myocardial Infarction

-40

-30

-20

-10

0

10

0 200 400 600 800

Case number

Es

tim

ate

d s

tati

sti

ca

l liv

es

g

ain

ed

/los

t

1/07/2004 13/06/2005 13/05/2006 23/03/2007 29/01/2008

VLAD Lower Control Limit 3 Upper Control Limit 3

Planning

• Western Australia Clinical Services Framework• Local information on volumes and utilisation• Demographic projections by local government

area• Comparison to National utilisation, bed days etc• Plan where our services will be

Clinical Service Redesign

MU1 patients, discharged by ward

3

8

6

11 7 6 8

0%

20%

40%

60%

80%

100%

Baseline Oct 15 toNov 14

Nov 15 toDec 14

Dec 15 toJan 14

Jan 15 toFeb 14

Feb 15 toMar 14

Mar 15 toApr 14

Perc

ent o

f dis

char

ges

Outlier

G62

G51

G53

G74-POD

G72

G61

MU1 patients, discharged by ward

3

8

6

11 7 6 8

0%

20%

40%

60%

80%

100%

Baseline Oct 15 toNov 14

Nov 15 toDec 14

Dec 15 toJan 14

Jan 15 toFeb 14

Feb 15 toMar 14

Mar 15 toApr 14

Perc

ent o

f dis

char

ges

Outlier

G62

G51

G53

G74-POD

G72

G61

Clinical Research

• As simple as “do we know if this program works?”

Elective Surgery

Elective Surgery

Health Service Administration

• Cost of service – efficiency and effectiveness

• Comparators• Everything should be able to be measured

against patient activity

Clinical Care

• Shared information:– Patient self management– All care providers

• Critically links to all other aspects

• Hence the patient will always remain central

Public Reporting• Nothing improves data quality quicker than being

in the public eye!

Summary

• The best human resources with an understanding of the importance of information– the advocates

• Patients as advocates• Physical assets to support standardisation,

automation and reliability• Consistent legislation to support use, but protect

individuals• Identify ROI / benefits realisation

So ….