Cross Talk on how we should all be healthcare specialists (but better informed ones than we are now…)
Mike Cross argues that Sir Derek Wanless is right to want more information about healthcare and its effects: and that this information should be distributed as widely as possible.
As a culture, we British are happy to admit ignorance of subjects like mathematics and statistics. In one scientific discipline, however, we think we’re all experts: health service management.
To judge by conversations I overhear in pubs and on buses, it's a rare Briton who doesn't think they could do a good job of allocating resources, assessing priorities and managing workflow in the NHS. (We also seem to have several million PhDs in healthcare informatics.) "Ideas tend to be based on anecdotal evidence and biased towards bad news, which circulates more quickly than good."
Politicians know the phenomenon all too well. Look at the way loyalties to party and policy evaporate when highly contentious local issues blow up: MPs of all parties dread being trapped on the wrong side of a local "postcode lottery" storm.
Pop economics
Rational experts may sneer at this tendency to assume knowledge and pander to popular superstition. But in one sense, our bus-queue health economists are on firm ground. Sure, their ideas tend to be based on anecdotal evidence and biased towards bad news, which circulates more quickly than good.
But so, too, are the ideas of many experts. I’m only exaggerating slightly here. A theme running through Sir Derek Wanless' latest review of funding and performance in the NHS, Our Future Health Secured, is the lack of solid, empirical evidence to inform policy.
In one lethal verdict he grumbles: "Data that would assist the monitoring of NHS performance remain so limited that some central questions about the relationship between costs and outcomes cannot be answered."
Indeed, Sir Derek says we lack so much as a starting base. While the national census gives us a ten yearly snapshot of how healthy we believe we are, "no equivalent information is collected routinely on NHS patients.”
Data from electronic health records
Sir Derek calls for "large scale trials" to explore the routine recording of the health status of everyone receiving any kind of NHS-funded care.
The benefits of measuring individuals' state of health would, he argues, range from better measures of productivity and comparative benchmarking through to the sort of information people and purchasers need to inform decisions about prevention of illness, treatment and commissioning.
Electronic health records, of course, will take us a huge step in that direction. Readers of this column don't need a lecture on how of the electronic record's ability to log and recall exactly what's done to every patient, and with what effect, in every episode of care, will transform medical knowledge.
One point needs stressing, however. When talking up the benefits of EHRs, we tend naturally to stress the difference they will make to individual encounters with the NHS. You know the stuff: your radiology images flashed up in a second; auntie Jen being saved a trek to the surgery thanks to electronic repeat prescribing, and so on. "Good data, widely disseminated, will equip politicians, bus-queue pundits and even journalists with a serviceable set of bullsh** detectors."
Heaven knows, all this needs saying. But we need to be careful that our stress on individual clinical benefits does not downplay or even denigrate the importance of electronic records to a wider community.
We need especially to beware the populist trap of dismissing healthcare management as a bureaucratic job-creation scheme, with less than legitimate needs for data.
Rational debate
There are two reasons why this is important, now. The first is that when managers (and researchers and drug companies) have access to good data, the quality of individual care improves.
The second is that knowledge is good for us. When everyone from the Secretary of State for Health to the bus -queue pundit is open to challenge on a point of information, the quality of debate should improve. Even on blogs and radio talk shows, perhaps.
Over the next few years, we’ll have plenty of chances to exercise our new knowledge; and not just in the UK. In the US, a national healthcare system is going to be back on the Presidential election agenda, whoever wins the Democratic Party’s nomination for 2008.
It may be too much to hope that good EHRs will turn us into a nation of health economists. But good data, widely disseminated, will equip politicians, bus-queue pundits and even journalists with a serviceable set of bullsh** detectors. Whether we use them is down to us.
About the author: Michael Cross is a freelance journalist specialising in healthcare informatics and e-government. He is a member of the British Computer Society.
Further Reading:
Review a feature about Sir Derek Wanless’ report and its implications for NHS IT
The full text of the report is available on the King’s Fund website