eHealth 2005 Conference – thoughts from day 3

Today’s conference had a different feel to it. Maybe because it was only a half day, or because there was no morning plenary session, but the conference just didn’t seem to have as much energy or buzz of the past two days.

Concurrent Session #1: In pursuit of a safe Canadian healthcare system
This session was facilitated by Dr. Michael Guerriere with Ross Baker, Matthew Morgan, and Susan MacLean making presentations on patient safety. The information presented paints a scary picture of health care, but I wonder if we are fear mongering. Patient safety seems to be the new narrative of eHealth and health informatics (more on that later) that seems to be rallying everyone around implementing and using electronic tools. If it works, let’s ride it.

Two things struck me as I listened to this session:

  1. Ross Baker talked about health care’s trend to go far past a safe “working boundary” that is recommended by experts. He Amalberti’s work on the phenomenon of “migrating to the boundaries”. I have never seen this concept expressed so.
  2. The expert panel discussed how there is a need to change the culture of reporting data (i.e., transparency as Richard Granger put it yesterday) to improve patient safety. Sunnybrook and Women’s College Hospital was used as an example of why hospitals are reluctant to share the data. Basically, Sunnybrook took a big step of admitting that they screwed up by re-using single-use needles and thus exposing hundreds/thousands of patients to blood-based diseases. The result? Well of course lawsuits and a settlement (I think). What the audience seemed to get out of the example was that hospitals are punished for admitting wrong-doing, and that this is wrong. What really irked me was this unstated and implied idea that the patients are somehow wrong for suing the hospital because it discourages open sharing of information. Sure, we want to change the culture of health care to disclose more, but are we then pooh-poohing the right to sue for damages? Aren’t civil actions a right that we have? If we take away this right to sue for wrongs done to them because we are trying to “change the culture of health care”, are we better off?

Matthew Morgan pitched an interesting idea of creating a national patient safety board, modeled after the national transportation safety board.

Concurrent Session #2A: Evaluation of a medication order entry system
Dr. Robert Wu and Mary Sanagan (both from the University Health Network) presented an evaluation of the hospital’s medical order entry system. They presented the results of a chart review and time-series analysis to see what the overall impact of this system was.

Some of the findings of the study included:

  • Errors (as defined by their study) actually increased after the system was put in place. This was identified as a “glitch” in the system of maintaining an “active” medication status even when the patient is discharged. Apparently this has been addressed in the system and will (hopefully) yield better results;
  • Physicians do not seem to directly benefit from the system at this time. Even though the physicians didn’t immediately realize time savings or other benefits, they continue to use it. I was very surprised at the utilization rates of other parts of the electronic system even before the system was put in place. The average for the hospital was 88%.
  • Users “stabilized” after about 150-200 uses of the system. Basically, users became accustomed to the system after about the 150th time they have used it. At the 150 point, the number of errors and efficiency in using the system stabilized and didn’t change much afterwards. I thought this was interesting.

From a “research” perspective, I was curious to hear that the evaluation team felt confident that they had sufficient data using one month periods. Maybe they utilized some of the continuous quality improvement (CQI) thinking of “plan, do, study, act” or PDSA. This issue is something that I’m currently wrestling with in my own research. From statistics, we know that short sample periods may not be indicative of the bigger picture. How much is enough?

Concurrent Session #2B: Human factors and the electronic health record
I jumped into this presentation halfway through to support my fellow colleagues at the Centre for Global eHealth Innovation. Anjum Chagpar, Peter Rossos, Jennifer Wong, and Joe Cafazzo presented on the work that’s being done using human factors/usability methods to evaluate (and design) elements of the electronic health record and medical devices. I must say that they did an excellent job of presenting a compelling case. I don’t think anyone in the room was left with any doubt that human factors testing should be an essential aspect of future projects.

Closing Session
The closing session had Alex Jadad share a few thoughts before turning the floor over to the invited guest: Mr. Mike Duffy (noted Canadian broadcaster). He is a very funny guy, and had the room laughing in no time. I was particularly impressed at his observation of the current political climate in Canada and its impact on health care. He observed that Canadians, and in particular Canadian politicians, seem reluctant to discuss changing the health care system. Maybe it’s because we hold it so dear to us. It doesn’t really matter why, but he pointed out that we should not be discouraged from engaging in meaningful discourse to make it better. Just because we talk about an idea doesn’t mean it will implemented. He likened the debate on health care as if it were becoming “radioactive” – that no-one wants to touch or discuss it. Great job on highlighting this point. He ended with a series of absolutely hilarious jokes/stories about politicians he’s covered. I’m sure he’s got a great number of stories to share.

Other Thoughts I’m going to post something tomorrow about this conference on things that struck me, ideas that are floating in my mind, and some future directions. I just want to let the ideas simmer in my brain for a bit before putting them down. Stay tuned for my final thoughts tomorrow.