By Dr Josie Di Donato PhD, MBA, BHA
Advocacy and Leadership Director, HISA
Imagine two parties conversing in their respective foreign language, exchanging knowledge about making pizza dough – the translation and exchange effort would naturally be two-way. Yet in healthcare, the research and clinical practice community exchange is typically one-way.
New research shows evidence is pushed via publication into health service delivery. Eventually, it is picked up in clinical practice but it is very much a slow burn. Knowledge translation is about research having an impact but more importantly getting the latest evidence in quickly.
To wrap our arms around the challenge of knowledge translation, consider the following figures shared by Dr Tamika Heiden at our Canberra discussion this month.
- There is a 17-year gap from when new research evidence is available to when it is used to change clinical practice.
- The pace of change is such that to be current and on top of your game, clinicians would need to read 20 journal articles per day.
- This translates to 30-40% of patients who are NOT receiving evidence-based care and 25% of care patients do receive is either not needed or potentially dangerous!
To compound matters we also waste research funds. We are spending billions of dollars on research, where it is known that it would have no impact on improved health outcome whatsoever.
Dr Heiden led a roundtable of thought leaders in discussion on knowledge translation that included: Government at State and National levels; Universities; Non-government organisations such as Primary Health Network; Horizons Health, Catholic Health, Hospital and Health Services Intellectual Property; Accenture.
Tamika challenged the status quo by arguing for closing the (knowledge) gap between research and clinical practice with greater stakeholder engagement so that the right problems/ questions are researched and funded (reducing the waste) and that we use knowledge more quickly than 17 years post.
So the rhetorical question to the health informatics community was, “ how can we use digital tools to transfer knowledge quicker into service innovation?”
- A push plus pull approach is needed: push research (as per usual) but undertake action research so that the problems at the point of care informs(pull) priorities for future research and funding. This requires engaging with the clinical community;
- STOP commercialising research that does not solve the problems of the health industry;
- “Digital health does not solve problems, people do”
- In the context of general practice, “We need to show the value (of knowledge) beyond the PIP (practice incentive payment)”
- The person who controls the microphone, controls the pace of change (this was a plea to our government leaders)
- Links between PBS and MBS is a no-brainer – but currently we have legislation that precludes data linkage between what is prescribed/dispensed to the patient problem
- eHealth term – stop using it because eHealth doesn’t make health different just because we use technology. Health is data driven (whether we use paper or technology). What is needed is organisational behaviour change.
- “There is no technology barrier, health organisations are designed for a different information age”. We need to ask the question, ‘how would you design a health system for the health needs of today.’ Once we can be honest about this then we can map back to today’s system so that it is clear what we need to do in order to move to that point. This will address the inertia and assist knowledge translation.
- Models of evidence are changing and the presumption of big data is a fallacy.
- Customer loyalty and reward schemes are not about accumulating points at all. These schemes give information about purchasing behaviour. Health could tap into this data source to address the obesity epidemic, for example
- Encourage the evaluation, feedback, benchmarking of what we are doing i.e. the health outcomes and patient experience. This will provide ‘lubrication” for changing entrenched practices that have no value
- Genomics of individuals compared to genomics of populations
It is clear the same old health informatics chestnuts would add value to knowledge translation:
- Standards and standardisation of data- needs government enforcement;
- Interoperability of software- needs government enforcement,
- Feedback built into software(gamification) so that clinicians receive feedback on their prescribing practice
- Privacy – is a transaction, not an absolute. Most people are happy to share if they get something of value in return.