If air travel worked like health care

probe

http://www.nationaljournal.com/njmagazine/st_20090926_4826.php

(There are a few countries where healthcare works better than airlines - eg Switzerland, France, Netherlands and Denmark) - but most systems would benefit by moving patient records and general resource management to a web based system.

Web based is much cheaper and more accessible compared with writing special software and setting up complex systems re-inventing the wheel (as they are doing in Britain* where the medical IT spend could run to GBP 20 billion).

*http://en.wikipedia.org/wiki/NHS_National_Programme_for_IT

www.google.com/health

drzhivago

probe wrote: »

http://www.nationaljournal.com/njmagazine/st_20090926_4826.php

(There are a few countries where healthcare works better than airlines - eg Switzerland, France, Netherlands and Denmark) - but most systems would benefit by moving patient records and general resource management to a web based system.

Web based is much cheaper and more accessible compared with writing special software and setting up complex systems re-inventing the wheel (as they are doing in Britain* where the medical IT spend could run to GBP 20 billion).

*http://en.wikipedia.org/wiki/NHS_National_Programme_for_IT

www.google.com/health

There was a comment like this by Bill Gates a few years ago about how much more advanced computers were than cars and if cars had advanced to the same degree we would be getting 1,000 miles per gallon, 150 miles per hour with no safety issues

The car spokesman smiled and said yes we would also have to expect our cars to stop for no reason, to need upgrades regularly, for help we would have to phone someone in an office who would blame the fuel manufacturer the tire manufacturer, the roads manufacturer as the reason the car wasnt working properly, ask you to remove everything from the car, unplug the battery, replace and restart as a test before you were put on a phone to technical support

You get the idea

Airline industry has some great safety innovations but would not necessarily want a health service run by airline personnel

REgarding the countries you mentioned, each have some very good points to their health service but equally some very bad points

The metrics used to measure dont do justice to any country really.

Have worked in many systems and the best of the best is in the US, that is if you are accessing care in the best hospitals, if not standards can be very patchy and far worse than we have in Europe or Ireland

Best fairest system I have seen in in Australia, good standard, good access, relatively fair price.

We would do well to watch their developments as they are still not happy with the standard there.

probe

By all means retain paper records if you wish (a computerised system would allow you to print out neat patient records for your paper files) – but the data should also be accessible on a need to know basis to other practitioners who have occasion to treat each patient. In real time. Wherever. Whenever. ie accessible over the internet on a secure basis. Anything less is surely systematic industry-wide medical negligence in this internet era? Practitioners have no right to hoard information which is really the property of the patient – and the patient should be free to provide access to it to any practitioner they wish. In a timely manner when they require medical service – which could be in an emergency, during a weekend.

With web based databases, one can have multiple backup systems in different locations updating each other - each accessible independently - eg if www.healthrecords.ie is down, you might have the option of going to www2.healthrecords.ie (based in another city - but containing an automatically replicated copy of the data). And if necessary a third option of www3.healthrecords.ie located deep in a mountain bunker in Sweden (just in case of a nuclear bomb attack on the two Irish centres). If your landline or cable broadband access breaks down at the client end, you could use a USB dongle 3G internet connection. On top of saving the data on your patients locally on your PC and having printed paper records. Have your cake and eat it over and over!

Centralised medical records facilitates statistical analysis of patient outcomes based on drug and other treatment options used, making it easier to determine the most effective treatments based on results on large numbers of patients who have similar conditions. Adverse drug interactions can be nipped in the bud. Drug companies could be provided with statistical information relating to their products, which could be used as a bargaining chip for lower drug prices and facilitate them in improving the product over time.

A practitioner might also consider the risk of their paper medical records getting lost or destroyed through no fault of themselves, their staff, or otherwise – eg fire, burglary, etc. Not to mention the systematic negligence issue of “the left hand not knowing what the right hand is doing” within the healthcare industry. While it is sometimes difficult to pin legal blame for mistakes caused by information “gaps”, it is usually the taxpayer who has to carry the can – either directly or through higher fees to cover PI insurance expenses of doctors. Which is immaterial compared with the health and safety of the patient.

Moving to the airline comparison, the entire medical profession needs to become more service oriented. Information management and administration efficiencies have a big part to play. In the context of airlines, Singapore airlines spring to mind. Or the low cost Swiss airline www.flybaboo.com in terms of overall quality of service. And while you might like to “throw stones” at airlines in terms of medical expertise and capability I have seen a flight attendant identify a PAX who was probably suffering a heart attack that nobody else even noticed, arrive with a defibrillator within 30 seconds or so, do exactly what the voice instructions from the device told her, move the nearby PAXs to other seats, clean up the mess and install new seat covers, and complete her normal job of getting the aircraft ready for landing. The ambulance service (at CDG) was in the aircraft the second it completed taxi, and the patient was removed before anyone else left the aircraft. This flight attendant is a star in my books. She is probably on 10% of the salary of the average Irish medical practitioner. And she has to do her “day job” as well serving passengers in flight attendant mode at all hours of the day and night while on duty.

In France and many other civil law countries, medical practitioners – and other professionals risk imprisonment and large fines for negligence. So they are very careful when it comes to information management.

A typical French pharmacy is a joy to visit compared with its Irish equivalent – again because of better IT management. With a repeat prescription, the pharmacist just calls up your prescription ("ordonnance") file on his/her VDU, checks that the prescription hasn’t changed, and presses a button. All the packages of medication arrive on a conveyor belt from an automated stock holding system within seconds and they put them in a plastic bag, take your money and you are out the door. No time wasted labelling each item, everything comes in the manufacturer’s box unopened – with full instructions on the manufacturer’s leaflet inside. Your prescription has the dose and other info – invariably computer printed and legible.

The typical Irish pharmacy experience is “would you like to wait, or come back in 15 minutes”, the use of pill counters (risk of cross contamination of medications), and opened packages of medication because there is no standard on what constitutes a month (eg is it 30 days, 28 days etc.) There is no excuse for this in relation to repeat medications that a patient is taking on a long term basis.

It appears to me that the Irish medical industry is a rather disorganised mess when it comes to administration and information management. And one is not trying to take away from the excellent work done by the practitioners themselves. It is not the clinician's function to be an IT specialist or to create an integrated information management system that is simple and works reliably.

It would be difficult to think of any other profession or industry that has a more vital interest in efficient information management of "customer" data.