Presented by Nick Baker General and Community Paediatrician Executive Clinical Director for Community Based Services, Nelson Marlborough District Health Board.

1. Nic k Baker
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A Clinical and a Pharmaceutical
Events Query Dashboard
Nelson Marlborough District Health Board
Nick Baker, Community Paediatrician
Donald Hudson, Business and Clinical Intelligence
Graham Parton, Chief Pharmacist
Montage Ltd.
Chip Felton, Principal Consultant, Visualisations

2. Information Needed for
Intelligent Behaviour
• Learning from experience
– modify services to meet needs
– improve effectiveness and outcomes
– enhancing quality and consistency
• Data is stored in many places
– is often inadequate
– collected in incongruent ways
– difficult to link to individual programmes of care

3. What is Clinically Useful?
• Personal health objectives
• right care, right place, right time,
• shared information, teams thrive
• Service level objectives
• audit, trends, effectiveness, planning, staffing
• Population health objectives
– target prevention
• age group, season, practitioners, regions
– evaluate interventions
– surveillance of trends
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4. First Attempt 1996
• data from each admission stored in Orocare
• 95 fields of data for every admission
• data extracted from oracle based system as a
spreadsheet
• imported directly into Access
• daily downloads possible
• database used to analyse data
• dataset filtered to extract a subset of admissions
• any fields can be used to control to data selected
– standard formats to view data graphs, tables.
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5. Data Selection
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6. Leading Causes of Hospitalisation
Nelson Marlborough March 94 - March 99 < 18 yrs
ICD9 Title
Tally
Days
1 DENTAL CARIES
1185
21
2 OTITIS MEDIA
1064
358
3 ASTHMA
635
1811
4 GASTRO-ENTERITIS
347
937
5 PREMATURITY
280
4334
6 HEAD INJURY
216
586
7 CHRONIC TONSILLITIS
178
224
8 ACUTE BRONCHIOLITIS
169
562
9 CONVULSIONS
153
347
10 URINARY TRACT INF.
138
315
11 ACUTE APPENDICITIS
129
652
12 VIRAL INFECT
122
177
13 PNEUMONIA
115
409
14 UPPER RESP. INF.
114
184
15 REDUNDANT PREPUCE AND PHIMOSIS
102
12
95
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Nick 16 PERIAPICAL ABSCESS
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7. Blenheim Asthma
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8. Asthma Annual Trends
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9. 2013
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•
•
•
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proliferating information systems – collaborative?
a large amount of data is collected
the data used for funding and reporting purposes
rarely converted into clinically useful information
lack of checks against clinical reality mean errors
can go unchallenged
• Information visualisation
– “The use of computer-supported, interactive, visual
representations of abstract data to amplify cognition.”
(Card, Mackinlay, Shneiderman, 1999)
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11. 2013 Tableau Reader Based System
From Data to Information
Multiple, Fragmented
Data Sources
Actionable
Information

13. Has New Clinical
Pathway Changed
Prescribing?
• Select Data
• Age group
• Medication
• Very complex queries possible
• Clinician driven hypothesis testing

14. Pathway + Education Sessions!

15. Where Might Further Targeted
Interventions Occur?

16. Costs of Oxycodone
• Includes direct medicine cost
• Numbers of patients treated
• Cost and claims per patient

18. Graphical Trends - Oxycodone

19. All Pharmaceuticals for < 5yrs
Five Slides for Graham

20. Disease Example

21. Admissions Over 75yrs

22. Admissions Over 75yrs

23. Clinical Uses So Far
• Reality check data
– look at coding, does result make clinical sense
• Answer Quick Queries
• Hospitalisation, pharmaceutical usage
– Emerging trends, identify variation, patterns
• Identify outliers provide focus for discussion
– Hypothesis generation/validation
– Identify at risk groups
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• Target interventions – falls, event management
• Prioritise
• Seasonal and temporal trends for conditions allow
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targeting of community interventions

24. Problems
• rubbish in rubbish out
– constantly refined
– test validity
• need knowledge of limitations
“out of sight out of mind
a blind idiot!”
– enormously powerful tool
– to jump to wrong conclusions and upset people
– best to let clinicians explain information
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25. Conclusions
• The system can
– allow rapid analysis of trends
– answer quick queries
– evaluate interventions
– be used for service planning
– be used to target population health interventions.
– useful addition to standard processes of clinical audit
• Extreme care is needed in using data collected by
non-clinical staff for non-clinical purposes to draw
epidemiological conclusions.
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26. Conclusion
• Information alone
“blind idiocy”
• Clinical judgement alone
anecdote
• Information + clinical judgement
clarification
• Clinically driven information selection and
visualisation
enlightenment and wisdom?

27. Acknowledgements
• Donald Hudson – Clinical Intelligence
• Graham Parton – Chief Pharmacist
• Chip Felton - Principal Consultant,
Visualisations, Montage Ltd.

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