February 1, 2013
CALGARY, AB, Feb. 1, 2013/ Troy Media/ – Thank you, Canadian Institute for Health Information (CIHI), for the opportunity to respond to the draft report Better Information for Improved Health: A Vision for Health System Use of Information in Canada.
Your report lays the ground work for how health information will be gathered, managed and used in Canada. It’s a big job. I know it’s difficult. But the draft report won’t help.
That’s because it’s a collection of data management dogma. It’s built on a foundation of assertions and assumptions, unsupported by evidence, in the promotion of a status quo; Big Data, Big IT, agenda. Solving problems in healthcare, or anywhere else, requires a scientific, evidenced-based approach. That approach starts with a problem and then searches for effective solutions.
In contrast, this report adopts the political approach, starting with a solution (Big IT), and then searches for problems. It’s rooted in the belief that all our healthcare problems can be solved by a faster, bigger, newer computer.
How’s that been working for us so far? According to Dangerous Enthusiasms: E-Government, Computer Failure and Information Systems Development, a study of e-government (and e-heath) initiatives in New Zealand and Australia, the answer is not too well. Schoolboy-like infatuation with the never-ending promises of new technology is now the butt of jokes and a well understood path to inefficient, ineffective, and inflexible bureaucratic service delivery. New and bigger isn’t always better. Sometimes, doing more with what we got is more productive.
Let me provide an example. A significant amount of money and effort has been expended on the CIHI Canadian Hospital Reporting Project (CHRP). It provides the comparative performance for 600 hospitals across the country, through an interactive website, presenting data on 21 clinical indicators, including readmission, caesarean section, and mortality rates, in addition to various cost and demand indicators.
The power of CHRP database was demonstrated when the project went live and identified St. Theresa’s hospital in Ft. Vermillion, Alberta, as the “most expensive to run hospital in all of Canada” ($8,930 per patient, compared to the national average of $5,168).
Is this the best CHRP can do? Manufacture cheap headlines at others expense? We need to solve problems. Serious analysis is required.
Is $8,930 abnormally high? Is it appropriate given hospital size combined with the impact of operating in Alberta’s north? What’s driving these costs? Is this figure trending up? Down? What’s the variation in operating cost month to month? Year to year? What does this variation tell us about the hospital’s operations?
The CHRP is incapable of answering any of these questions and, therefore, is doing nothing to “foster quality improvement, learning and action.” It’s not really a performance measurement system at all. More like an exercise in grade 4 math. We don’t need to spend millions to prove that, in any ranking, someone will be at the bottom (or that half will be below average). Nor do we need to dump on people doing an outstanding job in difficult circumstances.
Building a better healthcare system requires an understanding of how the work gets done, identifying the issues and constraints, and then finding solutions, including IT solutions, that fix them. Computerizing archaic bureaucracies won’t cut it. Neither will meaningless management news-speak, like: “To turn the vision into reality, robust and secure technological architecture needs to be designed, developed and implemented to simultaneously facilitate patient care and health system uses of information for decision-making.” Yes, and for world peace, we need everyone to get along with one-another.
Trash the report. This time, start with the people who need the information to deliver healthcare, instead of the converted believing the solution to every problem is a bigger gadget.
Troy Media columnist Robert Gerst is a Partner in Charge of Operational Excellence and Research & Statistical Methods at Converge Consulting Group Inc. He is author of The Performance Improvement Toolkit: The Guide to Knowledge-Based Improvement and numerous articles in peer-reviewed publications.
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