The power of data to make healthcare safer
I am in the school of pharmacy and medical sciences at the University of South Australia in Adelaide looking at the ceiling of Professor Libby Roughead’s office. ‘It used to be lower,’ she says. ‘We had to take out the overhead partition because somebody could have crawled through it’. This is one of the most secure offices in South Australia, perhaps the country. It is where data on the health of Australia’s 250,000 veterans is analysed. When a veteran receives their Gold card they are invited to consent to their medical information being reviewed to ensure they get the best possible care.
I am not allowed into the room which holds the computers and the data. But it is quickly obvious that what happens in that vault is world-beating. Professor Roughead’s team of clinical researchers, data analysts, behavioural and computer scientists are able to link a person’s medical information and then investigate whether the medicines they are prescribed are the best possible according to the evidence.
Every quarter, her team sends a confidential report to GPs across Australia making recommendations about possible improvements in treatment for veterans. Professor Roughead shows me a sample report (with fictional patient data) – it tells a GP which medicines their patient is currently taking and whether they constitute the best available treatment for their condition. The patient is also provided with educational resources to support them in self-management.
To my knowledge, there is nothing like this anywhere else in the world – and the results of the Veteran’s Medicines Advice and Therapeutics Education Services (MATES) initiative, established by the Department of Veterans’ Affairs (DVA) in 2004, speak for themselves. There have been significant improvements in getting people onto the medicines that are best for them – and a reduction in the prescription of medicines that could cause them harm. For example, there has been a 44 percent decrease in non-steroidal anti-inflammatory drug use in high risk patients leading to fewer hospitalisations caused by these medicines. There has also been a 14 percent drop in the prescription of anti-psychotics for patients with dementia. Professor Roughead shows me some graphs on her computer: her team was able to show statistically that prescribing these medicines could cause avoidable deaths for some people and GPs have changed prescribing as a result.
This service is available for former members of Australia’s armed forces but not for other citizens. This is because the DVA supports active monitoring of the health of individual veterans. Professor Roughead has long recommended to government that it permit these analytic techniques to be available for all Australians who want them – but, at the moment, only the DVA has the legal authority to link the data necessary to support these medicines reviews. ‘Every patient should expect their GP to have routine digital tools that will constantly assess the safety of their medications,’ she said.
The veterans’ data tells us some important truths about Australian healthcare today. She shows me a brilliant graphic which describes the actual lived experience of veterans with diabetes – a confusing bird’s nest of arrows and dotted lines. On average, they will interact with a health service more than 100 times a year and they will engage with eight or nine clinical professionals who do not generally have the ability to communicate safely and digitally between themselves.
This is the first time I have seen an accurate – statistically valid – description of the geography of Australian healthcare. ‘It is so disconnected. The patient should be at the centre of the care – but they are not,’ says Professor Roughead. ‘This is why the My Health Record system is so important. It should allow all the information about a person to be available to all the clinicians they encounter so that tests are not repeated and medications safely documented.’
Professor Roughead has spent her career promoting the improvement of clinical safety through better medications management. She says the statistics are clear: almost every patient admitted to hospital can expect at least one error of medications management where the system is paper-based – which is the case in many Australian hospitals. This could be the mis-recording or mis-prescription of a medicine. The Australian Digital Health Agency will be announcing plans shortly to improve the reporting of medicines in the My Health Record system, co-designed with expert clinicians and members of the community – a core clinical priority and one many people and their care providers have raised with me.
‘If the My Health Record contained a comprehensive list of a patient’s medicines – and was used properly, it would reduce errors,’ Professor Roughead said. ‘It would save lives.’
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