The document discusses using information technology to improve healthcare quality and reduce costs. It argues that applying information and technology can reduce costs, improve access, and improve quality. It then provides examples of healthcare budget cuts in several countries due to fiscal pressures. The document also discusses using data and evidence-based practices, clinical decision support, and engaging patients to help drive cost reductions and improve outcomes.

1. Healthcare Informatics Society of Ireland 16 th Annual Conference and Scientific Symposium Improving Quality and Reducing Cost in Health Care The role of information and information technology 16 – 17 November 2011 Professor Matthew Swindells Chair of the British Computer Society, Health Senior Vice President Global Consulting, Cerner Limited Visiting Professor, Surrey University School of Health Management

3. Budget pressures everywhere ... CANADA: From 2012–13 to 2017–18, the Ontario government will attempt to hold health-care spending increases to just 3 per cent per year. Over the last five years, health-care spending has risen by an annual average of 6.5 per cent. (March 2010) German Health Care Spending Cut, Fees Raised (July 2010) DANISH healthcare spending cuts (June 2010) ITALY: EUR24bn Austerity Package Contains Healthcare Spending Cuts (June 2010) SPAIN’s budget for healthcare has been decreased by 2.8 billion euros through a 19 billion dollar austerity plan. (WHO, June 2010) IRELAND: THE HEALTH budget will be cut by €1.4 billion between now and 2014 under the National Recovery Plan. (Nov 2010) ENGLAND: The NHS is expected to make savings of between £15- £20bn over the next 3 years. (Sept 2009)

4. Not just …

5. The cost of technology

7. How to drive cost reduction Make the institutions more productive Make the system more productive

8. Start by exposing data through portals

9. Rural Hospital Clinic Local Hospital Satellite Campus Pharmacy Rehab Surgery Imaging Center Nursing Home Government Physician Office Laboratory Healthcare System/Hospital (main campus) Then join up the parts of the system

10. Then drive process efficiency Schedule nurse time effectively Automate infusion management Integrated, actionable information availability Managing discharges to reduce readmissions

11. Reducing cost through the use of evidence

12. We know there is a great deal of variation 6 fold variance of your chances of surviving an aneurism across London 4 fold variance of your chances of surviving a stroke across London 10 fold variance of your chances of surviving a heart attack across London Despite 15 years of evidence based standardisation there is still wide variation in outcomes across the NHS Data 2005/06

13. Outcome against cost of intensive care No evidence that shows that spending more creates better outcomes or spending less creates worse Data 2005/06

14. How to address this - the use of evidence Arch Intern Med 1998;158:1665-8 Lancet 1995; 346:407-10 (courtesy Jeff Rose MD, Ascension Health) Strong evidence (RCTs) 57% Practice Based Evidence 27% No substantial evidence 16% (n=150 patients) Evidence-Base for Pneumonia Major therapeutic decision Not a major therapeutic decision Selection of antibiotic FBC on day 3

16. Cost Effectiveness of Evidence-Based Treatment Guidelines for the Treatment of Non–Small-Cell Lung Cancer in the Community Setting 12-month cumulative cost by Pathway status. Neubauer M A et al. JOP 2010;6:12-18 ©2010 by American Society of Clinical Oncology

20. Improve care with technology Support decisions with rules and alerts Guide clinical practice with executable knowledge Collect data as part of the care process Imbed real clinical evidence - Sepsis

21. Engaging the patient in managing their own health

22. Engaging the patient in managing their own health David Your blood pressure is a little high. A nurse will call you today.