Information Literacy and eHealth Heather Strachan Nursing, Midwifery and Allied Health Professions eHealth Lead eHealth Division Health and Wellbeing 27 th September 2007

Healthcare Revolutions 19 th Century Common Sense 20 th Century Science 21 st Century Technology The Institute of Medicine noted how crucial Information Technology is to all aspects of clinical decision making, the delivery of population based care, consumer education, professional development and research (2001)

Sustainable Healthcare Shortage of Human Resources – Need to value staff resource Increasing demand – informal care moves to formal care Increasing inequality gaps Rising healthcare cost Responding to uncertainty – mobility means rapid disease transmission Recognising purpose – keeping healthy not just treating illness

International Healthcare Trends Moving from intervening to emphasis on prevention and prediction Shift from emphasis on acute to community and primary care An increase emphasis on self care Removing the barriers to care from multiple sites Personalised medicine i.e. genomics

Better Health, Better Care Patient experience of care Best value and sustainable healthcare Patients taking responsibility Tackling health inequality Anticipatory care and long term conditions Give children the best possible start Continuous Improvement on Services

eHealth as a solution Improving access to health care and interconnect clinicians with Telehealth Equip the workforce to improve knowledge management and improve performance Inform clinical practice and improve public health through better knowledge management Improve health information for public to support health improvement and self care

eHealth successes or otherwise Automation √√√√ Connectivity √√√ Decision Making ×××× Intelligence ××××

Need to address 8 ubiquitous healthcare problems Errors and mistakes Waste Unknowing variations in policy and practice Poor quality health Poor patient experience Adoption of low value interventions Failure to get new evidence into practice Failure to manage uncertainty

Too much information! “We are drowning in data. Information is exploding. The world produced 5 exabytes of information a year. As information increased the value of each piece reduces and the probability of finding it reduces. Dr S Yunkap Kwankam, WHO, MEDINFO 2007

Too little time! Estimates show 5 years after a nursing student graduates 50% of the knowledge acquired will be obsolete. McCormick 1984 Seventeen years, on average, are needed to fully use study findings in clinical practice. Balas 2001

Getting it right and avoiding getting it wrong! More people per year are dying unnecessarily from medical errors than from breast cancer, AIDS or motor accidents. Lack of immediate access to patient healthcare information is the source of one-fifth of these errors. Dr Robert Kolodner CIO National Health information technology Co. USA MEDINFO 2004

The Knowledge - Practice Gap Use of statins for lowering cholesterol is viewed as one of 14 most successful medical interventions in last 30 years Fuchs et al million children under 5yrs old die every year – 90% in the developing world. 2/3 of these deaths can be prevented by available, effective, cheap interventions Jones et al. Lancet 2003

Benefits of Knowledge Management The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. WHO Constitution 1946 Knowledge is the enemy of disease. The application of what we know already will have a greater on impact on health and disease than any drug or technology likely to be introduced in the next decade. Muir Grey MEDINFO 2007

eHealth! A comprehensive set of information systems built around the Electronic Health Record. Delivering for Health 2005 The creation of a paperless clinical decision support and documentation system accessible to all healthcare providers, and their patients, across various settings in an integrated healthcare system: able to prompt, collect, store, aggregate and report data so as to provide accurate, easily retrievable information to both providers and consumers that promote the delivery of accessible, acceptable, efficient, high quality healthcare across the continuum of care and the attainment of the healthiest possible outcomes for all. Aurora Health Care, Wisconsin 2004.

Information literacy challenges for consumer of health care Identifying what information consumers want How to codify values and preferences Information retrieval systems that are easy to use, less troublesome than not having information How information is digested and best presented Education of consumers The change in patient/professional relationship

Information literacy challenges for clinicians and managers Identifying clinicians/managers information needs Use of controlled terminology to organised, share and retrieve information How to build decision support into the Electronic Health Record as part of work flow processes to support clinical decisions Skills in information literacy and knowledge management The change in organisational culture to an openness to enquiry and ongoing reflection

The National eHealth Programme Integrated Primary and Community Care System and Patient Management System Extension of Emergency Care Summary for patient access Scottish Health Information Service Information Governance Review Change and Benefits Programme NMAHP eHealth Managed Knowledge Network and specialist library Integrating eHealth competencies into NMAHP pre and post registration education

NHS Knowledge Services Knowledge support for clinical decision making. Health Information for patients and public and addressing health inequalities Developing knowledge competence and culture Implementing systems for sharing knowledge A Roadmap for NHS Scotland Library

Paralyzed or Prepared The growth in knowledge is huge, the need to filter and synthesis information is essential to keep up with the pace of healthcare discovery and apply it to clinical practice. Information literacy skills and tools can enable that learning for healthcare delivery.