Wednesday, December 10, 2008

A Dispatch from IHI

Today, I'm at the Institute for Healthcare Improvement Conference in Nashville, Tennessee. For the past 5 years, I've had the privilege of presenting the Information Technology workshops at IHI, focusing on the quality impact of EHRs and PHRs.

The highlight of IHI is always the keynote address by Don Berwick, CEO of IHI. Past presentations have included Escape Fire and Eating Soup with a Fork

I'm blogging this year's keynote in real time to capture the high points. The title of the presentation was "Tense". Don began with a poem by David Whyte called Loaves and Fishes

He noted that hospitals have to report 1500 different quality and performance measures to hundreds of organizations demanding compliance. This takes incredible energy and feels chaotic.

In the past, IHI has tried to organize this chaos into 5 "portfolio areas"
Continuum of Care
Population Health, Experience of Care, Per Capita Cost
Developing Nations
Professional Development

Don hypothesized that 80% of healthcare can be reduced to approximately 100 processes. If we focus on perfecting these 100 processes, we're likely to make a major impact. IHI will soon implement an Improvement Map as a next step to the 5 million lives campaign. He highlighted three new focuses for IHI

Quality and Financial Management - increased value
Prevent Catheter associated urinary tract infections
WHO Surgical Safety checklist

Atul Gawande took the stage and spoke about the WHO Surgical Safety checklist - SignIn, TimeOut, SignOut. Early pilots suggest it may be the most powerful way for hospitals to reduce harm.

Don announced a challenge to all the hospitals in American - a sprint to implement the WHO Surgical Safety Checklist in 90 days.

Don then described the future by reading two letters that he's written for his daughter Jessica to open in 20 years, describing two healthcare futures.

The first was an apology that we failed to reform and improve healthcare, we tried and failed because change was too hard. The second described the success of change embraced and resistance overcome.

The summary of Don's remarks is that we must cut through the chaos and the overwhelming amounts of data, instead focusing our efforts on just a few high value projects that will create definitive results.

As I wrote in my blog entry Data, Information, Knowledge, Wisdom , simplifying our care processes and ensuring every patient gets the right care at the right time is not only a good idea, it's a necessity.


John Stuart Mill said...

Dr. Halamka: What do you make of IHI's admission that it cannot say for sure what impact its 5 Million Lives Campaign had? IHI had earlier claimed sweeping success.

To my knowledge, that assertion of success was challenged only by Drs. Pronovost and Wachter, albeit in devastating fashion.

Austin said...

I hope you had a great time in my hometown. I took my last final exam as a undergrad this morning at the University of Tennessee. I am trying to get on board at CHS for another internship before I start my real job at Ernst and Young! I love reading your blog and I hope the weather was not miserable while you were in Nashville.

John Halamka said...

Answering John Stuart Mill - In his keynote, Don noted that the methods to analyze error/harm are still in development and that he does not have all the data he needs to reach a conclusion - yet. My guess is that as the National Quality Forum/Health Information Technology Expert Panel collaboration with AHRQ and HITSP is widely implemented, quality measurement will become much easier and the impact of IHI's work will become clearer.