qi4gp

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qi4gp the quest for wisdom
Harry Pert
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The information/knowledge hierarchy
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Origins of the knowledge hierarchy

• Where is the Life we have lost in living?
• Where is the wisdom we have lost in knowledge?
• Where is the knowledge we have lost in
  information?
• TS Eliot
• Choruses from the Rock. 1934

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Russell Ackoffs path to wisdom
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What then is wisdom?

• Vision and design creating a preferred future.
• Needs to be collaborative, but could include
• Patient Centred Professionalism.
• The best health outcomes,
• as safely as possible,
• with minimal waste,
• consistent with community values.

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How can general practice help?

1. Our health service
2. Our IT platform
3. Clinical governance

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The health service in New Zealand

• Every day
• 55,000 people visit a GP
• 1,350 people admitted to hospital
• Every year
• 3.38m people visit a GP (80 1 yr, 90 2 yrs)
• 15 -19m consultation
• 30 - 40m clinical decisions made
• Enrolment, NHI, HPI
• Increases accountability

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Observations, questions success factors

• Why general practitioners use computers and
  hospital doctors do not British Medical Journal
  2002
• Good software, and connectivity (PMS
  Healthlink)
• Culture early adopters
• Business model
• New support for general practice from the early
  90s
• Clinical leadership
• Management support

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New tier of support for general practice a
vehicle for clinical governance
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Our first IT installation 1989

• Server 13k
• 2 terminals 2.5k
• Printer 2.8k
• Total 30.8k

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I.T. Strategy Discussion Paper
Ranolf Medical Centre
Date 21st November 2008 Prepared by
Michael Humphrey (Technical Director) Scott
Whitwell (Sales Director)
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Observations, questions success factors

• Our experience is consistent with international
  literature and evidence.

Over 150 factors identified, but only two
top management support and clinician involvement
consistently associated with successful
implementation Lack of clinician involvement
has been a consistent theme in past failures
Dennis Protti BJ Healthcare Computing and
Information Management Dec 2003
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Observations, questions success factors

• Funding
• Largely self funded
• No pattern of state funding
• Expertise
• Infrastructure in place
• Many years of experience
• the burden of prior innovation

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• The major phases of qi4gp

Clarify Develop the Vision
An Initial Perspective
Implement the Vision
Apr 07
Aug 07
Dates TBC
Current Phase
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2
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1
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3
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Broader Stakeholder Engagement
Plan to Implement
Initial Stakeholder Engagement
Agree Projects / Partnerships
Draft Discussion Paper
Plan Next Steps
Final Discussion Paper
Final Strategy Document
Track Progress
The Key Directions Project
Stage 1 Business Case
Consultation Document
Detailed Requirements / Solution
Stage 2 Business Case
High-level Requirements / Solution
Implementation
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Information collected Demographic Name, Age,
Gender, Ethnicities (affiliations) Address
(standards, geocode) NHI Funding
eligibility Clinical Prevention,
screening Conditions
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Relationship remains central Reactive care ok
for acute conditions More structure needed for
long term conditions
Long Term Conditions Proactive Structured
Acute Conditions Reactive Unstructured
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National Regional DHB/NGO Network Practice Ind
ividual
Population a group of individuals sharing a
particular characteristic eg age, gender,
ethnicity domicile, deprivation index health need
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National Regional DHB/NGO Network Practice Ind
ividual
Activities eg children needing
immunisation flu vaccination women needing
mammograms cardiovascular risk assessment new
migrants refugees patients diabetes, copd
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National Regional DHB/NGO Network Practice Ind
ividual
opportunity we could measure manage any
health problem access, utilisation outcome
inequalities improve the care of the individual
and inform the sector
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Increasing role of the patient at the centre of
health care (cf the provider and organisations)
For information to follow the patient through
the health system Referrals, status, discharge,
shared records, interconnectivity
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Self care trusted information Access to
records, appointments, results etc Information
about providers services, facilities,
performance.
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Clinical governance is a system in which NHS
organisations are accountable for continuously
improving quality of their services and
safeguarding high standards of care by creating
an environment in which excellence in clinical
care will flourish
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Clinical governance is a system in which NHS
organisations are accountable for continuously
improving quality of their services and
safeguarding high standards of care by creating
an environment in which excellence in clinical
care will flourish
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Quality Improvement Local delivery through
networks. Quality cycles Measure performance,
feedback, peer review, intervention review
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Where to from here?

1. We must create an environment in which
   excellence in clinical care will flourish
2. All national GP organisations support this
   project
3. We want to share this development with you
4. Common ground, needs, unifying purpose

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The patient safety agenda

• US medical error in US hospitals
• 98,000 deaths per annum (Save 100k)
• gt MVA, breast cancer and aids combined
• Australia
• Inappropriate medicine use,80,000 hospital
  admissions, cost 350m
• gt550,000 avoidable admissions a year, (9)
• NZ
• ?
• adverse events in Auckland Hospitals
• 10 of admissions
• 1 permanent injury or death, 7 extra bed days.