Information Technology : Improving care with technology

Patientrack is software response to global health administration problem recognised by Dr Michael Buist, New Zealand clinician and intensive care specialist now working in Australia. It is designed to save thousands of lives that are lost every year in hospitals around the world.
In the late 1980s Buist became concerned about the number of people who came to his intensive care ward and died. Many of them, he realised, were not coming through the hospital’s front door, but rather from the hospital’s own wards.
He and group of clinicians did research in the early 1990s that led to the recognition and acceptance of phenomenon called ‘adverse events’. It happens when hospital patients get sicker because of the treatment and care they receive, or don’t receive, rather than because of the illness for which they were originally admitted.
The medical profession was, in general terms, aware of the problem. It had not, however, been defined and was certainly not topic that invited either discussion or even ready acknowledgement. Studies now show that up to 10 percent of all hospital admissions are affected by an adverse event, and as many as 10 percent of those affected, die. And, according to other Australian and UK studies, between 50 to 70 percent of adverse events are avoidable.
Up to 98,000 patients die from adverse events in United States’ hospitals each year, 40,000 in the United Kingdom and 18,000 in Australia. Extrapolating those figures suggests around 3000 patients die in New Zealand hospitals from adverse events each year.
Buist’s intensivist work in major Australian hospitals led him to conclude that early diagnosis of patients most at risk and early access to high level clinical assistance for them was key to solving the problem.
In the late ’90s and early years of 2000, Buist – West Coaster by birth and upbringing – became the champion of Australia’s concept of medical emergency teams, designed to counter the adverse events problem. He discovered, however, that while the processes created for early diagnosis and treatment could significantly reduce the incidence of misadventure, they did not work well enough to satisfy him.
Hospital ward cultures and procedures would, even with the best treatment and care intentions, too often mitigate against the right things happening.
The solution, Buist decided, lay with the use of information technology specifically designed to support the medical response processes. Patientrack is the outcome. And, after 14 months of trialling by the Central Manchester University Hospitals National Health Service (NHS) Foundation Trust (CMFT), it has been declared success.
Patientrack won the prestigious UK Healthy Service Journal prize for “improving care with technology” as result of adopting and rolling it out to all adult and children’s wards in CMFT’s hospitals. CMFT also won an eHealth Insider award for the “best use of IT to promote patient safety” through its use of Patientrack.
The software delivers three critical patient management processes. It captures and manages the patient observations. Then, using an algorithm, it calculates and allocates an early warning score based on medical team observations. Finally, and uniquely, it takes the early warning score and runs the hospital medical response policies according to the score.
If, for example, patient has score of three, then junior doctor might have to see the patient within an hour. score of five might require that consultant should see the patient within half an hour. Hospitals set their procedure rules.
Patientrack generates the message and sends the message on the pager or whatever communication device is used. “The last thing hospitals need is another system that bleeps or flashes,” says Patientrack director and business development leader Sam Hollander. “We don’t bleep or flash. We send the message to an individual who is meant to respond.”
The message recipient is told the patient’s name, the ward, the bed number and time by which they must respond. If they don’t, they can be sent second message or it may be sent to another person or to their direct report. “It doesn’t let go of the issue. It requires the correct response,” says Hollander.
A daily report provides all the management detail necessary to identify the efficacy or otherwise of internal responses, procedures or over-stretched resources. “You don’t need to wait for Royal Enquiry to find out what happened and why,” he adds. “This will generate report that tells whether critical observations are being taken and whether people are responding within the required time. All that can help management of the hospital’s resources in variety of ways.”
Patientrack was designed to achieve clinical objective, to reduce the number and impact of adverse events, says Hollander. “And because of that we realised we must do clinical trial to prove the efficacy of that. We chose CMFT because doctor in charge of intensive care there, Jane Eddlestone, chaired the national committee that was looking into improving care for the acutely ill in hospitals.
“We figured that given she was the authority in the UK, and if we could run the trial in her hospital, if she was convinced (by the outcomes) we had product. If she wasn’t, she would have saved us money by not going any further or doing something else,” reasons Hollander.
The Patientrack team decided to commercialise the product in the UK because of its large, national health system and the potential for high global profile if successful. It also seemed like more logical launch point for approaching the US and European markets. Efforts are, however, also being made to sell Patientrack in to the Australian and New Zealand hospital management markets.
The Manchester trials provided the developers of Patientrack with insights they never had about the ways in which hospitals respond to better management practices and procedures and how IT can improve patient care outcomes. They showed, for example, that not only could they lower the number of patient deaths, they could also shorten hospital stays and make better use of resources, says Hollander.
The Patientrack story is yet another example of New Zealand’s talented diaspora succeeding in complex and sophisticated global markets. M

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