Improvement on Patient Care, Integrated Systems Management thru Health Informatics [Interview][Transcript]

Professor_Andrew_Georgiou_Macquarie_University

Guest: Professor Andrew Georgiou
Presenter: Wayne Bucklar
Guest Bio: Associate Professor Andrew Georgiou is based at the Centre for Health Systems and Safety Research of the Australian Institute of Health Innovation, Macquarie University. He is currently an Editorial Board member of the International Journal of Medical Informatics and the Journal of Pathology Informatics. Andrew was recently appointed as the co-Chair of the International Medical Informatics Association Working Group on Technology Assessment and Quality Development (2013).

Segment overview: For our Health Academy Series today, we are joined by Professor Andrew Georgiou from the Macquarie University to share his research on health informatics and how it assists health practitioners maintain continuity, better coordination and improvement of patient care. Professor Georgiou has a broad range of research interests including knowledge management, health care evaluation, research methods and equity. Also, he has worked as a senior researcher in a number of areas including primary care, chronic disease, aged care, health informatics, outcomes measurement and organisational communication.



Transcription

Health Professional Radio

Wayne Bucklar: You’re listening to Health Professional Radio. My name is Wayne Bucklar and this morning it’s Health Academy and my guest today is Professor Andrew Georgiou. Andrew is an Associate Professor at the Center for Health System and Safety Research and that’s part of the Australian Institute of Health Innovation at Macquarie University Hospital. Andrew welcome to the Health Academy and Health Professional Radio.

Andrew Georgiou: Thank you, really pleased to be with you.

W: It’s our pleasure to have you on this morning. Now Andrew most of our audience are clinicians of one kind or another, often working in acute care and they’re always interested to know what’s happening in the world of academic research in the academy generally. Tell me what’s your area of interest?

A: So my area of interest is Health Informatics. Health Informatics involves some the roles that information and communication technologies can play in improving the quality and safety of health care. Health Informatics is a pretty broad area so within that area, I’d say that my particular specialty that has been in the area of pathology or laboratory ordering, where clinicians make orders for pathology test alongside medical matching. I’d become very interested in that area as well and I guess the other area that I have a particular interested in I’ve done on lot of research in is in aged care informatics and that’s where clinical systems and administrative systems can help in the better coordination and improvement of care for aged people in the community in particular.

W: Now for many years in Health, IT and Informatics is pretty much restricted to coding and making sure the billing was done correctly. It’s in recent time has been a fairly hefty investment around the world and in Australia in systems that are actually involved in bringing information technology to patient management in a clinical sense rather than in a financial or administrative sense. That’s the field you’ve been working in I gather, what’s happening?

A: Yeah, so you’re right IT or Information Technology in the old days tend to be a very a specialist sort of thing that was mostly around billing or coding or it tends to be limited to a particular sections. There might be one section at the hospital that attends to the IT system but it was just that section rather than throughout the hospital. So we have now moved on, what’s happening is that we’re getting integrated systems so we have a team called “the electronic medical record” which what that does in a hospital set is that links up to data saved from the pathology lab to the administration data to other elements of critical information. So a clinician or a doctor say might be able to access information at one point, and it’s not just going to three different places, that’s all there in front of them. So it maintains a continuity in the sense you know what’s going on immediately and by knowing the information about a patient, when you come to order a pathology test or put together an order for medication, you actually also get to know things that are important to maintaining the safety and the quality of that person’s care. So for instance if there’s some sort of an adverse reaction that might become because the patient has a certain condition, you might have that information or it might be part of the decision support feature of the system. So for those reasons, the fact that we’re now talking about a hospital wide system, that we’re now able to integrate information, that we’re actually starting to see the potential for massive improvement. So it’s no wonder therefore that a lot of governments or health planners, administrative bodies think that this is a great way to improve health. That there’s efficiency involved and there’s lots of benefits that are potentially out there.

W: You’re listening to the Health Academy with Health Professional Radio. My name is Wayne Bucklar and I’m in conversation with Professor Andrew Georgiou. Andrew, there’s some level of cynicism about the adoption of electronic health records and IT generally in the health system around the world. There’s been a number of, I guess you call them “high profile cases” where systems have not gone into use at the cost and time frames that were expected. Sometimes there’s a push back from clinicians who described as it’s turning them into data entry experts or cook book medicine. What’s you’re feeling from your research? Is this a program that’s going to be successfully implemented globally?

A: So that’s a very good question and it’s something that I think time will tell. It is true that particularly in the 90’s when I first got involved in Health Informatics and Health Information Technology and I was working in NHS in Brisbane at the time. There was some massive failures, very expensive failures where things actually went terribly wrong and there was a lot of rethinking that went on. I think the other thing about that was I think the NHS at the time coming around the turn of the century, they actually even had that grand plan to put together the NHS information strategy which wanted to introduce electronic systems and it didn’t go according to plan, and overspent and so many problems with it. I think there’s been a lot of rethinking about it and one of the things that’s become very clear is that IT, the introduction of IT to health care has lacked that strong evidence base. What’s happened is that there’s a sense of “Oh well here’s an IT system, it’s gonna work. It’s gonna improve, let’s just put it in there” rather than a sense of “Well, should we evaluate it? Should we make sure that there is evidence for it? Should it be safe?” I mean we do have a lot of conditions for introducing new products in health, new surgery, new drugs, how come we don’t have that same attention to IT systems which are incredibly expensive and actually have a potential to cause harm as well? So yeah, it’s been an up and down story, I think for every great new story there’s also occasional bad news story. And sometimes the bad news stories dominate, for instance if a system goes down one day, everyone in the middle of day went down maybe rather than the 348 days when everything was fine. So yeah it is very challenging but I think that with the role that I see myself playing and our Centre for Health Systems and Safety Research is that we really want to provide the evidence base for making good decisions about the designs of these systems, about their implementation and about sustainability because there’s too often a sense of putting it in and that’s it. We need to have systems that are sustainable. They change over time and improve overtime actually.

W: Yes. And I guess in the success side of the coin, private pathology has been running Health Informatics very successfully for a long time now. And also intensive care, there’s been ICU systems that are being implemented and working effectively for a good a while. Is this going to be a generational change that we have to wait for a new generation of doctors with iPads before we see wide spread acceptance?

A: Actually my feeling is that we’re already seeing those changes. And sometimes it’s not so much an age thing, it’s more just to prove that it works, confidence that it can work. But the problem, not a problem – it’s probably better to say the challenge with Health Information Technology is when you introduce a new system and actually change the things dramatically, so for instance initially when we introduce new ordering systems there was a tendency to design that just like it was a piece of paper. So you design a screen just like it was a piece of paper, so you’re filling in the piece of paper. And the problem with that is IT has much flexibility, computers can do a lot more things, and you don’t have to fill in things in twice, three times, four times. So IT allows us to be innovative, so we need to have a sense of we’re making innovations. Now innovations cause major disruptions, they cause major changes. And unless you’re prepared for them, unless you’ve sort of predicted them or able to deal with them, there’s likely to be a bit of concern … perhaps a bit of resistance to new systems. So I think that these are the challenges, IT’s not just a substitute for paper. It’s actually a new concept and has to be thought of like that. So I’ll give you an example, when a new system in an emergency department there’s always a lot of concern about time and efficiency. Lots of people coming thru, we need to sort of make sure that there’s a smooth flow of patients through the hospital through the ED. Now initially ED, there’s a lot of stories about how slow the computer system made to adopt and there’s a feeling of if you measured the time it takes a doctor to make an order on a piece of paper to the time it takes to make an order on the computer, the paper is quicker. And I remember almost a decade now, we even sort of recorded the time and looked how things changed and sure enough, when a doctor makes orders they might make them in a great bulks sort of time that the end of every three hours or something and they just scroll through them and it’s all done very quickly. Whereas with a computer you actually log in, log out wait for it to come up, there’s all sorts, get the checklist to do all the things you need to do. So on that level, you could say that computers didn’t make things more efficient but when you’ve done it once, that’s it throughout the hospital. So the same things might not be right at that one point of time, it might be just as a system you are now, you now have the order in there, the patient details in there, it’s accessible to everybody, people could see it. It’s not like you have to run over through a cabinet or a drawer to pick up a piece of paper, bring it back and look at it – it’s all done. So we tend to look at it like it was a substitute for previous way we’re doing things, IT should be seen more as an innovation. We have to change the way we plan and do things. And that sort of innovation, that sort of change, is not very easy. If you don’t have a good research background, you don’t have evidence about things, people could sort of turn off very quickly. So I think we’ve made improvements in that, there’s more less resistance to IT, I think there’s a greater … there’s more agreement about the potential that IT can have to change things. And I think that the other thing is that IT is no longer just a new thing, I mean it’s part of our world. It’s hard to imagine existing without information technology so that’s what in a hospital, a new IT system doesn’t come in like the first time anyone has seen a computer. It’s now a new system that replaces the old system.

W: Yes.

A: So it’s part of our environment now. And I think there’s a greater acceptance for that so therefore to challenge us to provide the evidence and to evaluate and to improve things as part of, just that the part of the plan to implement.

W: And Andrew do you have a sense that evidence is emerging that Health Informatics improves patient outcomes in quality and safety?

A: So there is evidence about it and in some cases it’s very dramatic, in some cases maybe not so dramatic. So in my area, when we introduce pathology ordering systems where doctors can make orders on a computer, we were able to show dramatic improvements in turnaround time. That is the time that took an order to go in or request, a pathology request to go into the lab to the time a report was seen. So in some cases it’s up to 15 minutes. Now on the ward, perhaps that doesn’t make that much of a difference, I mean a doctor might still go on rounds and whether it comes in 15 minutes earlier or not probably doesn’t make that much difference. So whether in an ED, in an ICU, in a critical care setting – time does matter so that’s important. So there’s much, there’s a lot of evidence about that but then there are these other things. One of the big issue that’s been debated around at the time is unnecessary ordering or major variations in ordering of tests and medications and medical images. Now our study shows and one that we’ve done actually quite recently is that we looked at the difference between paper ordering and pathology electronic ordering and we found that the electronic ordering changed things dramatically. There was less ordering done, why? One of the reasons that this over ordering is that sometimes a doctor doesn’t know that a patient had this test an hour ago or another doctor has put in a request.

W: Yes.

A: So this is a duplication and sometimes they get picked up or often times they don’t. So that when you can go to a computer and say “okay, well look at that patient has had that test two hours ago, there’s no need to do that again.” So that even that basic thing, basic piece of information could help improve the quality or the appropriateness of ordering. So yeah, there is evidence like that. In other things it gets a bit more complex, so there’s a lot of interest in things like patient portals. Patient portals which gives patients the information, the test results and they can actually access it through a hospital information system where they get to log in and they able to see their own record and maybe even to get their result. Now that’s a very exciting concept, a lot of people are very much for it because it encourages patient participation. It makes the patient management more a collaboration but the evidence about how much good it’s doing? It’s a little bit more difficult because it’s a patient having access information is a right, you’d say it’s valuable but the evidence about where it’s actually shown to be of value to everybody, it’s a bit harder to judge that. So there’s many issues like that that we need to confront and we need to deal with.

W: Andrew it’s been fascinating talking to you this morning, I’m conscious of the time but we haven’t even touched on personally controlled of electronic health records and the national scheme or data security and a whole lot of other things that I’ll be fascinated to talk to you about and hear your views.

A: Yeah.

W: We’ll leave that for another day perhaps.

A: Okay, fine.

W: Today I’ve been talking with Professor Andrew Georgiou about Medical Informatics. If you’ve missed our interview and you’ve just tuned in, we have a transcript of it on our website at www.hpr.fm. We also have a SoundCloud archive and you can find this interview on YouTube as well. Andrew, thank you for your time this morning. It’s been a pleasure talking to you and I’m fascinated to discuss things further with you on another occasion.

A: Thanks very much.

W: My pleasure. This has been the Health Academy with Health Professional Radio, my name is Wayne Bucklar.

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