Information exchange is the core of a safe, efficient and effective health system. The Centre for Health Systems and Safety Research (CHSSR) conducts innovative research aimed at understanding and improving the way in which health care delivery and patient outcomes are enhanced through the effective use and exchange of information.
Health systems internationally are coming under increasing pressures driven by demographic, social and technological change. Existing models of health care delivery will not be sustainable in future decades. Information and communication technologies have a significant role to play in creating opportunities for new models of care delivery. Examples range from telemedicine applications supporting care delivery in the community to sophisticated clinical decision support systems accessible to clinicians at the point of care.
Such interventions are designed to improve the efficiency, effectiveness and safety of the health system. Health systems around the world are making vast investments in such technologies often with limited evidence regarding the extent to which these systems will deliver desired benefits.
Our research centres on designing rigorous and innovative approaches to evaluate these health informatics interventions and to apply these methods to provide evidence of effectiveness, efficiency and safety. A unique aspect of the Centre’s work is the application of rigorous evaluation approaches which bring together highly quantitative methods grounded in epidemiological techniques married with the use of qualitative approaches including techniques such as video observational studies and social network analyses. We focus upon investigating and measuring both expected outcomes, for example reduced medication error rates following introduction of electronic prescribing systems, as well as unexpected outcomes in care delivery such as changes in the nature and amount of face to face communication between health care providers.
The Centre is internationally recognised for this work and constitutes the largest health informatics evaluation research team in Australia. Our work is highly competitive with other international research teams in this area and our research program is characterised by strong engagement with national and international academics from a board range of disciplines, health practitioners, government bureaucrats, policy-makers and information system industry leaders. We aim to make significant scientific contributions to the disciplines of health informatics, health information management, evaluation methodologies and safety and quality in health care. Further we seek to promote the translation of our research findings into health care policy, implementation and evaluation approaches within the health care sector.
Please click here to watch Professor Johanna Westbrook discuss the research of the Centre.
Our vision is to lead in the design and execution of innovative health systems research.
Our mission is to produce a world-class evidence base which informs policy and practice, focusing on patient safety and the evaluation of information and communication technologies in the health sector.
The Centre's research is underpinned by a systems perspective, exploiting multi-methods. Our research team is characterised by their talent and enthusiasm for working within and across discipline areas and sectors. The Centre has a focus on translational research, aimed at turning research evidence into policy and practice.
The Centre's research program has four central aims:
The functions of the Centre are to:
This will be achieved through:
Health care delivery is associated with a large number of avoidable errors that lead to patient harm. These errors are associated with a significant burden of morbidity and mortality on the Australian population. Our scientific understanding of the fundamental causes of error remains poor. This project aims to make a fundamental contribution to improving our understanding of this problem, and suggest initiatives which can improve the safety of health care in Australian hospitals.
The exchange of information amongst health professionals and between health professionals and their patients is a core element in the provision of safe and effective health care. Communication events make up over 80% of hospital doctors and nurses’ time. On average doctors are interrupted 15 times per hour and senior clinicians have even higher rates of interruption. Information exchange may be disrupted within health care settings in many ways and may have serious and often negative consequences. Within hospital settings we still have a relatively poor understanding of the amount or nature of communication which occurs and this limits our ability to design better ways of organising and supporting care delivery.
The incorporation of information technology into new health care delivery models promises improvements in both the safety and efficiency of care delivery. Medication errors are one of the most significant safety issues for health care systems. Medication management occupies a significant amount of nurses’ time, and is also fraught with error potential. One-third of all medication errors that cause patient harm arise from medication administration errors (MAEs). Electronic medication administration records (e-MARs) provide the potential to make the administration of medications safer for patients by reducing error rates, and also by allowing nurses to manage medication tasks more effectively. However it is not known whether this is actually the case. Hospitals in Australia and overseas are implementing eMARs in the absence of any rigorous empirical evidence that these systems are effective in achieving reduced error rates or in making nurses’ work more efficient.
In this research we have conducted prospective, controlled observational studies to determine the effectiveness of an electronic medication administration record (e-MAR) to reduce MAEs and the amount of time nurses spend in the medication administration process. The results will have important implications for hospitals across Australia and internationally as they consider the implementation of e-MARs. The study focuses on the generic features of e-MARs and therefore results will be generalisable across the main commercial e-MAR systems available.
Health systems face considerable challenges in meeting increasing demands for highly sophisticated services with limited resources and a shortage of health professionals. The introduction of information technology (IT) is a key strategy to meet these challenges. Health systems internationally are making vast investments in IT. Yet there is clear evidence that we may not obtain a good return on this investment as we do not know the best ways to use IT in the health sector to create new ways of working which improve productivity and safety. This research is working on developing tested models for how IT can be used to support innovative work practices and will measure the impact of these on productivity, safety, efficiency and cost of services.
Australia must develop and implement new models of health service provision to increase capacity and reduce errors within workforce and resource constraints. Working with one of the largest area health services in NSW this project will address this challenge. The results will directly benefit the community by creating and testing new models for how health professionals can use information technologies to improve the safety, quality and efficiency of health care services delivery. The findings will underpin national efforts to improve the productivity and effectiveness of the health workforce and its ability to respond to changing demands. The effective use of IT is a critical enabling factor for national productivity and growth.
Missed test results are a critical safety issue. It has been estimated that 10-15% of diagnoses are incorrect and poor follow-up of critical diagnostic tests is identified as a major preventable cause of this problem. Doctors acknowledge that the way they manage test results for their patients is not systematic. It has been reported that 17-32% of physicians have no reliable method of ensuring that results of all tests were received and that only 15% are satisfied with their system of notifying patients of abnormal results. The aim of our research in this area is to evaluate technological applications which support the efficient and safe management of test results.
The significance of this work is underscored by the substantial costs associated with ordering multiple tests for patients. Diagnostic testing accounts for a large proportion of health care costs and is increasing. Our own research has shown that on average hospital patients have over 100 test assays performed during their inpatient stays. Effective test management procedures are essential to ensure that results of all tests ordered are reviewed with appropriate follow-up action initiated and communicated to general practitioners.
This research includes one of the few studies internationally, and the first Australian study, to quantify the extent of the problem of missed microbiology and radiology test results in an Emergency Department of a major metropolitan teaching hospital. We have also conducted the first systematic review in this area which quantified the extent of the problem for inpatients including patients attending emergency departments and the impact of missed results on patient outcomes. Both publications pointed to ways in which technology could be used more effectively to reduce the number of missed results.
Across Australia and internationally there are significant investments underway to promote the uptake of major health IT systems such as Computerised Provider Order Entry (CPOE) systems and Picture Archive and Communication Systems (PACS). These systems have the potential to make a major contribution to the efficiency and effectiveness of pathology and medical imaging services and therefore to the quality of patient care. CPOE systems allow clinicians to order diagnostic tests for pathology and medical imaging directly via a computer thus eliminating the need for cumbersome handwritten orders which have a huge potential for error. These systems can also incorporate clinical decision support features to maximise the delivery of evidence-based care and best practice. In medical imaging PACS provides an economical means of storing, rapidly retrieving and accessing medical images across different modalities and sites.
Our work in this area aims to investigate the effect of these systems on how work is carried out and their impact on key indices of pathology and medical imaging performance, particularly relating to: efficiency (value and efficacy of services in terms of cost, time and standards of practice); effectiveness (the best possible outcome) or success of the intervention; and quality (ensuring that the right process is performed well and meets identified needs and other relevant standards). This work has contributed to the development of a suite of interconnected performance indicators which can be used to provide comparative evidence about the key areas where these systems are expected to positively impact on the quality use of pathology and medical imaging, including: