Health System Dashboards and Quick Wins

It’s been nearly 2 months since my last post. So much has happened since.

Last week I attended a health forum with government and health industry leaders from around Australia. It was both broad and enlightening. My contribution was to promote the need for a consumer focus – along the lines of this recent post. I believe this message was well received by all – except those with entrenched interests such as the medical specialist colleges and health bureaucrats.

At that forum it was predicted that the COAG meeting of 2 weeks ago would achieve no significant reform agreements. Indeed this is what happened – although perhaps with good reason. As Kevon Rudd pointed out, this may need time to get right. The cynics would say we’ve had enough time.

My future goal for this blog is to shift towards promoting simple tools that will provide measurable improvement to our health system. These may be medications, IT or process tools that can be implemented at any level. I will endeavour to give some kind of health economic and regulatory rationale for their implementation. I will also try to outline how these incremental changes can shift healthcare back towards a balanced market.

My first quick win is a health dashboard.

The dashboard is a concept familiar to many in other industries, particularly to business analysts. A dashboard collates and displays information, typically relating to performance. In the case of health, the dashboard could display data for a family health clinic, or indeed for a large hospital or even at the national level.

Healthcare is information rich but data poor. The fact that few of our established pieces of health infrastructure use dashboards demonstrates this. I am aware that hospitals use them in some capacity – but only a limited number of staff have access to them. I know that some GP clinics, particularly those run by corporate groups, have software that can extract this type of data – albeit in a limited format such as a summary of Hb1Ac levels for all your diabetic patients.

Healthcare must move from a reactive art towards a predictive model. A great example of this are radiology dashboards in Baltimore. The idea is to provide data for decision support. Only with overview displays can staff quickly foresee changes and gaps that need to be filled.

In Australia dashboards could be easily applied at the primary care, aged care and hospital level. Most of these facilities already have databases with the relevant information. But doctors have few clues about how to make use of this data. We concentrate of the traditional tools of EBM, diagnosis and management while easily losing sight of the bigger picture.

While policy makers get excited about performance incentives, they need to first consider a far more simple measure of providing overview.

Managing Radiology

Recently a friend of mine injured his shoulder. He asked me what I thought he should do and after  brief physical examination I suggested he go to a physio for treatment. There did not seem to be any indication of instability, bony tenderness or signs of serious injury. He instead went to his GP who suggested a shoulder x-ray, which, not surprisingly turned out negative for any fractures. So I was very interested to read that in the USA there are now companies that manage radiology referrals, essentially screening them to check that the referral is appropriate.

There is a good article here explaining the advantages of radiology benefit management.

The Latest in Imaging: Photoacoustics

Imagine being able to image lesions below the skins surface in 3D, or visualising the network of blood vessels into which you are about to cannulate.

Photo-acoustic imaging technology had been in use in academia for years. Now various companies are in the process of commercializing it. The approach provides optical imaging quality at the depth of ultrasound and can view different tissues without contrast media such as iodine. 

How does it work? Photoacoustic imaging is a hybrid biomedical imaging modality based on the photoacoustic effect. Laser pulses are delivered into biological tissues where

 it is absorbed and converted into heat, leading to transient thermoelastic expansion and ultrasonic emission. The generated ultrasonic waves are then detected by

 ultrasonic transducers to form images. 

Here are some examples of its application:

1. 3D imaging of a melanoma in-vivo (right)

2.  Thermoacoustic image of a mastectomy specimen (left).

The malignant breast tissue generates a much stronger thermoacoustic signal than the surrounding benign tissue due to its high microwave absorption.