Garbage in, garbage out

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Garbage in, garbage out

• Alastair Bishop
• Head of Change Benefits
• Scottish Government eHealth Directorate

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A computer lets you make more mistakes faster
than any invention in human history with the
possible exceptions of handguns and
tequila. Mitch Ratliffe
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Overview

• Quality in health care
• Information quality
• eHealth strategy
• How do we improve information quality?
• Questions

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What is (health care) quality?

• Safe
• Effective
• Efficient
• Timely
• Equitable
• Patient-centred

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Quality is not asserted by the NHS it is
perceived by the patient.
Anon
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What is information quality?

• Intrinsic
• Accuracy
• Objectivity
• Believability
• Reputation
• Contextual
• Relevancy
• Value-Added
• Timeliness
• Completeness
• Amount of information

• Representational
• Interpretability
• Ease of understanding
• Concise representation
• Consistent representation
• Accessibility
• Accessibility
• Access security

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What is information quality?

• Fitness for purpose

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Garbage in, garbage out
Anon
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eHealth strategy

• Ensure technology contributes to making health
  care
• Safer
• Smarter
• Better

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eHealth strategic principles

• Confidentiality safeguards are an obligation
• Exploit what exists and fill gaps
• Focus on benefits, supported by technology and
  change

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eHealth strategic principles

• Virtual patient record, not a large single
  database
• Technology development, standardization and
  convergence
• Collaborative approach to delivery, drawing on
  good practice

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Confidentiality

• Who should see what?
• Opt-in or opt-out?
• Consent
• Informed
• Explicit or implicit?
• Presumption to share or to hide?
• Access model complex or simple?
• Let the patient see their record, and who else
  has seen their record

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Mere allocation of huge sums of money for quality
will not bring quality.
W. Edwards Deming
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Exploit what exists, fill gaps

• SCI Store
• SCI Gateway
• Emergency Care Summary
• CHI
• PMS
• PACS

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The purpose of medicine is to prevent significant
disease, to decrease pain and to postpone death.
Technology has to support these goals if not,
it may even be counterproductive.
Dr Joel J Nobel
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To improve quality, improve process
Anon
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Change benefits

• eHealth supports NHS Scotland in improving its
  services
• Benefits are our focus before, during and after
  doing eHealth stuff
• Benefits happen because people and processes
  change
• Technology enables and supports people to change
  the way they work

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Technology is like a fish. The longer it stays
on the shelf, the less desirable it becomes.
Andrew Heller
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The fog of information can drive out knowledge
Daniel J Boorstin
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Virtual patient record

• We are not going to throw everything away and
  replace it with one big system
• We will join together what we have
• For the user, it will look like one big system
• Single sign-on
• Everything in one place
• Standards are vital to make this work

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Motivation is what gets you started. Habit is
what keeps you going. Jim Ryun
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Standardization convergence

• It isnt necessary that everyone uses the same
  system
• It IS necessary that every system can talk to the
  outside world
• It isnt necessary that everyone uses a different
  system!
• Standards are essential

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The real measure of performance is not how you do
at your best, but how you do at your worst.
Subir Chowdhury
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Quality is everyones responsibility.
Anon
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Collaborative approach

• eHealth will be done with you, not to you
• Encourage innovation spot good ideas scale them
  up across Scotland
• Not always one size fits all
• Work with service improvement colleagues

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Whos who?
eHealth Directorate
Strategy Division
Architecture Design Division
Programmes Division
Change Benefits Division
Intelligence Research Analyst
eReferral Programme
CHI Programme
Benefits Team
Change Team
Clinical Leads
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How do we improve information quality?
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Inaccurate information might result from either a
deliberate attempt to deceive or mislead
(disinformation), or an honest mistake
(misinformation)
Hernon
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The problem is not the people, it is the system.
Anon
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You can not inspect quality into a product.
Harold F. Dodge
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Auditors are those who visit a battlefield and
shoot the wounded
Anon
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The thickness of the Quality manual is inversely
proportional to its effectiveness
Anon
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Automation applied to an inefficient operation
will magnify the inefficiency
Bill Gates
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Its always been done this way.
Everyone
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Make wrong actions more difficult
Anon
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Do not find fault, find remedy.
Anon
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The bitterness of poor quality lingers long after
the sweetness of meeting schedule
Anon
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Technology can hide information quality problems
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