Translating data to make a measurable impact on clinical care: Clinicians working to effect system change Professor Chris Bain MBBS, Master Info.Tech., PhD (Info. Sys.), MACS, AFCHSM, FACHI Professor of Practice – Digital Health – FIT Professor (Adjunct) – FMNHS Digital Health Lead – Monash University Acting Director – HELIX, Monash University HISA HDA Event 2018 – Tuesday 22/10/2018
OVERVIEW • Starting assumption is ….. this is a good thing (of course !!) • Getting there in a SYSTEMATIC fashion will be a surprisingly tough journey though I’d argue …. • What are the biggest challenges …and why ? • How do we overcome them ?
HEALTH RECORDS IN AUSTRALIA 1 Seropian R, Reynolds BM. Computer analysis in surgical investigation facilitated by optically scanned input. Am J Surg. Dec; 120(6):710- 3 ….. Year ?????? 1970 !!!!!!
HEALTH RECORDS IN AUSTRALIA 2
HEALTH RECORDS IN AUSTRALIA 3 • SO WHERE ARE WE AT IN AUSTRALIA ? • GP computerisation is above 90 % • But overall - successful technology “penetration” into healthcare in Australia is WILDLY VARIABLE ….. in a range of ways ….. Uptake of accepted / known technologies – eg – EMRs HIMSS EMRAM L6 (0-7) – Aus – 3 hospitals Vs US – Q3 2017- 32.7% of n=5,480 (1792 hospitals !!!!) Acceptance of new technologies Footprint size and profile (often a $ issue) Relative maturity of different types of technologies (eg – SMR vs AI) …. but this is not unique to healthcare
NOVEL END USER DEVICES The REHEARSE-AF Study at the ESC congress • 2 groups x 500 older adults • 1 year • Routine care vs 2 x ECGs per week • 4 times better at picking up AF
CHANGING CARE PARADIGMS “Monitoring of the central blood pressure waveform via a conformal ultrasonic device” – published in Nature Biomedical Engineering – 11/9/2018 by Wang et al …
USER / “TRAINEE” VARIABILITY “A clinician isn’t a clinician isn’t a clinician” • Disciplines across health (Nursing, Med etc) • Variation within disciplines (eg – ICU / Anaesthesia often involved in IT /data ….. vs psychiatry) • Anecdote … Cardiologist doing his own ML !! • Exposure as part of their formal education (UG /PG) • Age bands • Interest
“FLOATING THE BOATS” 1 ……
“FLOATING THE BOATS” 2 ……
THEN THERE’S STILL …. • Workplace culture • Evidence and logic vs politics • Enabling the staff to make the right decisions and changes – support structures (eg - policies / governance as blockers) • Data ownership as a power base = politics • Historic delay between evidence and translation into care (? 17 yrs) • Ongoing upskilling and uptooling !!!! • Finding the patient / family a place in this (NB - Open Notes / SPM)
So an exciting future that we MUST cautiously explore … and a challenge in harnessing and using all that data to the stated end … THANK – YOU. chris.a.bain@monash.edu @monashdigital
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