qi4gp & the quest for

wisdom

Harry Pert

The information/knowledge hierarchy

Wisdom

Knowledge

Information

Data

Origins of the knowledge hierarchyWhere 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

Russell Ackoff’s path to wisdom

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.

How can general practice help?1. Our health service

2. Our IT platform

3. Clinical governance

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

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

New tier of support for general practice: a vehicle for clinical governance

GP GP

Local networks

RHA, HFADHB MoH

Management Support• Contracting• Claims processing• IM/IT• Analysis and planning • Practice support

Quality Support• Clinical leaders• Clinical specialists• Peer (cell) group • Quality facilitators• Pharmacy and lab• Immunisation & child health • Education organisers

Our first IT installation 1989

Server $13k 2 terminals $2.5k Printer $2.8k

Total $30.8k

Ranolf Medical Centre

Date:21st November 2008

Prepared by: Michael Humphrey (Technical Director)

Scott Whitwell (Sales Director)

I.T. Strategy Discussion Paper

Observations, questions & success factors Our experience is consistent with

international literature and evidence.

Dennis Protti BJ Healthcare Computing and Information Management Dec 2003

“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”

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’

The major phases of qi4gp

52

Initial Stakeholde

r Engageme

nt

8

Clarify & Develop the Vision

Clarify & Develop the VisionAn Initial PerspectiveAn Initial Perspective Implement the VisionImplement the Vision

Apr 07

The Key Directions Project

Stage 1 Business

Case

Agree Projects /

Partnerships

Broader Stakeholde

r Engageme

nt

1

Draft Discussion Paper

4

Plan Next Steps

3

Final Discussion

Paper

Aug 07 Dates TBC

7

Plan to Implement

6

Final Strategy

Document

Consultation Document

Detailed Requirements / Solution

Stage 2 Business

Case

High-level Requirements / Solution

Current Phase

Implementation

9

Track Progres

s

qi4gp

patient

centred

populationclinical

governance

individual

qi4gp

patient

centred

populationclinical

governance

individual

Information collected

Demographic

Name, Age, Gender, Ethnicities (affiliations)

Address (standards, geocode)NHI

Funding eligibility

Clinical

Prevention, screeningConditions

qi4gp

patient

centred

populationclinical

governance

individual

Long Term Conditions

Proactive Structured

Acute Conditions

Reactive ‘Unstructured’

Relationship remains central

Reactive care ok for acute conditions

More structure needed for long term conditions

Relationship remains central

Reactive care ok for acute conditions

More structure needed for long term conditions

qi4gp

patient

centred

populationclinical

governance

individual

National

Regional

DHB/NGO

Network

Practice

Individual

Population

a group of individuals sharing a particular

characteristiceg

age, gender, ethnicitydomicile, deprivation index

health need

qi4gp

patient

centred

populationclinical

governance

individual

National

Regional

DHB/NGO

Network

Practice

Individual

Activitieseg

children needing immunisationflu vaccination

women needing mammogramscardiovascular risk assessment

new migrants & refugeespatients & diabetes, copd

qi4gp

patient

centred

populationclinical

governance

individual

National

Regional

DHB/NGO

Network

Practice

Individual

opportunity

we could measure & manage:

any health problem access, utilisation & outcome

inequalities

improve the care of the individual and inform the

sector

qi4gp

patient

centred

populationclinical

governance

individual

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

qi4gp

patient

centred

populationclinical

governance

individualSelf care: trusted information

Access to records,appointments, results etc

Information about providers: services, facilities, performance.

qi4gp

patient

centred

populationclinical

governance

individual

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

qi4gp

patient

centred

populationclinical

governance

individual

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

qi4gp

patient

centred

populationclinical

governance

individual

Quality Improvement

Local delivery through networks.Quality cycles

Measure performance, feedback, peer review, intervention & review

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 you4. Common ground, needs, unifying purpose

The patient safety agenda

US: medical error in US hospitals 98,000 deaths per annum (Save 100k) > MVA, breast cancer and aids combined

Australia: Inappropriate medicine use,80,000 hospital

admissions, cost $350m >550,000 avoidable admissions a year, (9%)

NZ: ?

adverse events in Auckland Hospitals 10% of admissions 1% permanent injury or death, 7 extra bed days.