Optimism Marks Opening of the MedInfo 2007

BRISBANE, Australia — In case anyone hasn’t noticed, health care is undergoing a shakeup. Again.

“We’re in the middle of the third health care revolution,” said Sir Muir Gray, director of clinical knowledge in England’s National Health Service (NHS), during a keynote address Tuesday to MedInfo 2007, the 12th world congress on health informatics.

The Third Revolution, according to Gray, will be flexible, pervasive, inclusive, and convergent, with information driving technology. “Information technology is one of the drivers of the third health care revolution.” Other forces of change are knowledge and patients, who are demanding something better than the status quo, Gray said.

The first health care revolution took place in 1850s London, said Gray, when common sense led to the discovery that a deadly cholera outbreak was caused not by miasma, but by the unsanitary water of the River Thames. The second, a science-based revolution marked by advances in pharmacology, diagnostic tools, and treatment techniques, has been underway since 1950. “We can attribute in developed countries about half of the increase in life span to the second health care revolution,” Gray said.

But he believes the revolution of the last half-century has not solved the eight “eternal problems” in health care: errors; poor quality; waste; unknowing variations in the provision of care; poor patient experience; the “overenthusiastic” adoption of techniques of questionable value; failure to move new evidence into practice; and failure to manage uncertainty.

“The application of what we know can mitigate the eight problems,” Gray contended, then offered an interesting explanation: “Clean, clear knowledge is like clean, clear water,” Gray said. “The development of clean, clear water provisioned health care in the 1800s. The development of clean, clear knowledge will transform health care in the 21st Century.”

Indeed, Gray repeated a line that has gained him some renown in the United Kingdom: “Knowledge is the enemy of disease.”

But new knowledge requires new processes. “The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade,” Gray said.

Instead of delivering information through traditional means — either directly or through a dedicated supply chain — Gray suggested that it could reach practitioners and patients via clinical networks built on knowledge.

He said that the NHS is trying to boil down esoteric knowledge from scientific journals into easily understood guidance that, for example, could be embedded in laboratory request and order forms.

“Who wants a 140-page Word document? What people want is a picture,” Gray said. He showed a slide of a lengthy journal article, with a small part of one page highlighted. That, according to Gray, is all a clinician really needs to know from that particular article.

“We’re introducing the concept of one-minute learning,” said Gray. That happens to be about the attention span of the typical physician while treating a patient, and for a patient listening to a doctor.

“I’ve been giving patients information for 30 years, and it doesn’t work,” Gray said. Instead, he wants to find ways to get clinicians and their patients closer to knowledge. “The first thing I do always is employ librarians,” he said, since they specialize in finding and organizing knowledge.

That is exactly what he did with the Down’s Syndrome Screening Programme, which he’s set up as a knowledge-based organization to assure that 600,000 women get consistent service from a web of NHS bureaucracies. Gray noted that he had a budget only for a Web site, not for midwives, so he had his librarians stock the site with actionable information. “This is all there is, but it’s all it needs to be,” he said.

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