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.

The Elements of Influence

Why is influence important?While many of us need to influence others in our work and personal lives, we are aware that bare persuasion doesn’t always work. Influence really means being aware of others needs and leveraging their likes and dislikes to help them act.

From Robert Cialdini interviewd on Smartplanet.

There are six universal principles of influence. If we use them as touchstones, they will allow us to be significantly more successful in our influence attempts. They are:

• Reciprocation. People give back to you the kind of treatment that they’ve received from you. If you do something first by giving something of value—be it more information or a positive attitude—it will all come back to you.

• Scarcity. People will try to seize those opportunities that you offer them that are rare or dwindling in availability. This is an important reminder that we need to differentiate what we have to offer that is different from our rivals and competitors. That way, we can tell people honestly “You can only get this aspect or this feature by moving in our direction.”

• Authority. People will be most persuaded by you when they see you as having knowledge and credibility on the topic. You’d be surprised how many fail to properly inform their audience of their genuine credentials before launching into an influence attempt. That’s a big mistake.

• Commitment. People will feel a need to comply with your request if they see that it’s consistent with what they’ve publicly committed themselves to in your presence. The implication there is to ask people to state their true priorities, commitments and features of the situation that they think are most important. Then align your requests or proposals with those things. The rule for consistency will cause them to want to say yes to what they’ve already told you they value.

• Liking. People prefer to say yes to your request to the degree that they know and like you. No surprise there but a simple way to make that happen is to uncover genuine similarities or parallels that exist between you and the person you want to influence. That person is going to like you more and be more willing to move in your direction.

• Consensus. People will be likely to say yes to your request if you give them evidence that people just like them have been saying yes to it too. I saw recent study that showed if a restaurant owner puts on the menu “This is our most popular item” than it immediately becomes more popular.

Wollemi College Stem Cell Presentation

You can find the PDF file of the presentation linked here (file size 7.3MB).

Where Consumers and Pharma Meet

There is an ongoing debate in pharma about how to best interact with consumers in a useful and ethical manner. While it is clear more people are using the web to find health related information, there seems to be some division about who they trust. In this article

Can you put trust in your online doctor? (Image: Fraser Hudson)

, Richard Meyer, president of Eyeforpharma.com suggests that pharma won’t succeed in the social media space.

The other major issue is the quality of the information. There are various approaches to this – Google has been talking about how to optimise it for years. Some studies reported here in New Scientist are interesting in that they suggest the average quality of info derived from you standard Google search is ‘poor’.

Fixing America’s Health

There is no quick fix. But I admire Obama for getting his hands bloody. If the least he achieves while in office is a debate near the scale we are having, I think he’s done better than most. To have so many industry leaders offering cost-concessions is already quite a coup.

WSJ has offered a few great articles of late that give an overview of the aims, the history and the objections to Obama’s reform.

First up, they answer ten key questions about the overhaul. It begins with, what is the problem anyway? Their answer – high costs and a lack of coverage. They also point out that the oft-quoted figure of 46 million without health-coverage is artificially inflated.

Their second point is that there is one point of universal agreement -compensation should be outcomes-based, not based on the quantity of procedures. Easily said, difficult to do.

The next question is about Democrat/Republican differences. While I don’t know if the divide is straight down the middle as suggested, there certainly are some strong dissenters in the Republican camp. Bobby Jindal thinks the reform will make the same mistake Hillary did in ’93 and ’94 – philosophical over-reach and lack of consensus building. Then he reinforces WSJ’s second point – that pay should be performance based. Closely tied to that is the need for consumer choice guided by transparency (including electronic health records).

The final points really say two things: it will be expensive, and it will probably happen this time around despite a history of failure.

WSJ's Summary

Obama has taken to highlighting the example of places like the Cleveland Clinic. The clinic has got many things right, and most notably, is involving patients more in their own care by allowing them, for instance, to upload their own information into their health records.

Mobile Phones the next Health Platform

Mobile phones could be the next major platform for personal health monitoring tools, experts say.

In the future, people could use mobile phones to share, store and add information to their personal medical records. In addition, people with chronic conditions could use special add-on devices to monitor diabetes, blood pressure or oxygen levels in their blood.

In an iHealthBeat Special Report by David Gorn, experts discussed the potential applications of mobile health monitoring technology.
http://www.ihealthbeat.org/special-reports/2009/mobile-phones-could-store-electronic-health-records-boost-personal-health-monitoring.aspx

Appendectomy helps Ulcerative Colitis

From 6minutes.com.au:

Up to 90% of patients with ulcerative colitis may have their symptoms resolved or improved after having their appendix taken out, a leading gastroenterologist has shown.

In a preliminary trial in 30 patients with ulcerative colitis who underwent appendicetomy in the absence of appendicitis, 40% showed complete remission for up to 25 months and no longer required drug treatment, according to Professor Terry Bolin of the Prince of Wales Hospital in Sydney.

A further 50% of patients showed some improvement in the ulcerative colitis symptoms and only 10% showed no improvement, Professor Bolin and colleagues report in a study in the American Journal of Gastroenterology this month.

Real World Clinical Trials are Needed

We have yet another example of a drug that does not offer the benefit originally claimed.

A ‘real world’ study of Implanon use by women in Australia demonstrated that about half have the implant removed early, usually because of abnormal bleeding.

While most companies track drug adverse events, they don’t measure ongoing success. The need for ‘pragmatic’ or real world trials is obvious, but few are undertaken. This is partly because the money is not available to run them.

My hope is that the development of digital records and practice management systems will soon provide the real world data we need to truly improve healthcare including drug use.

The Anti-Aging Pill

Recent news of a pre-clinical trial that unexpectedly showed anti-rejection drug Rapamycin extend the lifespan of mice has set the world abuzz.

The article below goes as far as to suggest that there might be off-label sales akin to those of human growth hormone:
http://industry.bnet.com/pharma/10003037/wyeth-discovers-anti-aging-pill-by-accident-its-rapamune-an-organ-transplant-drug/

I think you’d be crazy to start taking this drug for it’s anti-aging effects. It has a list of side-effects as long as my arm. But it could point to a mechanism for limiting cellular degeneration and preventing cancer.

For now, I’ll stick to the low-cal diet.

‘Devout Christian’ to Head NIH

Whenever anyone says someone is a ‘devout Christian’ I am skeptical. But I’m happy to hear we will have someone that believes faith and science can coexist. Francis Collins, famous for leading efforts to sequence the human genome wrote “If you believe that God is the creator, how could the truths about nature we discover through science be a threat to God?”. “For many scientists who believe in God–including me–it’s just the opposite. Everything we learn about the natural world only increases our awe of God the creator….”