Health Informatics: Case Studies to Improve Patient Care

Case Study I: Health Promotion

We are still in reality in the early stages of making good use of IT in the health sector, but already there are examples where better information has facilitated an improvement in health care. In many but not all cases, this has been facilitated by the use of technology to provide that information.

In the 1990 GP contract in the UK, a new emphasis was placed upon health promotion. This was facilitated by incentive payments to GP practices who met targets for screening and immunisation activity. Early examples were cervical screening and child immunisations. This was often accompanied by subsidies to practices to purchase computer systems.

Peto (2004) argued that the cervical screening programme established in 1988 has prevented an epidemic of cervical cancer cases:

"Cervical cancer mortality in England and Wales in women younger than 35 years rose three-fold from 1967 to 1987. By 1988, incidence in this age-range was among the highest in the world despite substantial opportunistic screening. Since national screening was started in 1988, this rising trend has been reversed.

Cervical screening has prevented an epidemic that would have killed about one in 65 of all British women born since 1950 and culminated in about 6000 deaths per year in this country. However, these estimates are subject to substantial uncertainty, particularly in relation to the effects of oral contraceptives and changes in sexual behaviour. 80% or more of these deaths (up to 5000 deaths per year) are likely to be prevented by screening, which means that about 100000 (one in 80) of the 8 million British women born between 1951 and 1970 will be saved from premature death by the cervical screening programme at a cost per life saved of about £36000. The birth cohort trends also provide strong evidence that the death rate throughout life is substantially lower in women who were first screened when they were younger…"

The Lancet 2004; 364:249-256

Although some small practices ran very effective screening programmes without computers, such a large scale screening programme would not have been feasible without the widespread growth of computers in primary care.

Case Study II: Computerised Guidelines

Computerised guidelines offer benefits to help the UK NHS deliver consistent high quality treatment. For example:

"Stockport Primary Care Trust is tackling heart disease in an aggressive and co-ordinated way. All of the PCT’s 59 practices have developed validated CHD registers, and are now implementing guidelines for managing CHD and hypertension. This activity has been supported by dedicated CHD facilitators, the production of a detailed handbook covering disease register development and treatment guidelines, and the use of computerised templates for decision support and data recording. Central to the success of the programme have been financial incentives, combined with intensive support to practices in the form of facilitation and educational initiatives, including the PCT’s protected time scheme."

Source: UK NHS Modernisation Agency

Through implementation of the National Service Framework, the Department of Health calculates a reduction in mortality from coronary heart disease of 27% from 1996 to 2004. Many of the risk factors are managed through computerised screening such as that described above.

Case study III: The Power of Information

In order to achieve benefits, it is worth remembering that it is information that enables change and better care and the technology is merely the delivery vehicle (although at best, it is a very effective delivery vehicle!)

A number of years ago, I found myself in a West African country in the middle of a meningitis epidemic. The epidemic started in the country next door. The disease spread rapidly in the absence of any adequate control mechanisms.

The epidemic was detected, when a visitor from the country I was in returned home to his family. Unfortunately, he brought the meningitis with him and started a new centre of infection. Although he was living in a relatively isolated town, there was a rudimentary disease surveillance system in place. A local health care worker noticed a sudden increase in the number of meningitis cases.

He rang the central disease surveillance team in the capital; a days travel away and started to count how many people got ill. They didn’t have any paper, so first they had to scrape around for some that was only written on one side. So they wrote on the back of envelopes, bills, anything they could find. Soon they were joined by the small team from the capital. They were able to demonstrate that they had a full blown epidemic on their hands.

Using their very limited information resources, they were able to:

· demonstrate to donor agencies their need, resulting in an influx of vaccines and drugs.

· design an immunisation strategy that stopped the spread of the disease, resulting in many fewer deaths than in the country of origin.

Further Reading

Gillies AC (2006) The Clinicians Guide for Surviving IT, Radcliffe Publishing, Abingdon