health & science

‘Swiss cheese’ health system loses heart data

A health system riddled with holes and suffering from “information chaos” is responsible for thousands of patients not getting the best prescription for heart disease.

A study comparing data from different health databases found almost 40 percent of patients who spent time in hospital with cardiovascular conditions did not have this recorded in health records held by their GP. Prior cardiovascular problems are a high-risk factor for future heart health issues.

This resulted in over half of those patients not receiving “triple therapy” treatment because their future heart disease risk was incorrectly assessed by the prediction algorithm used by many GPs.

Triple therapy - a combination of blood pressure-lowering, lipid-lowering and antiplatelet/anticoagulant medications - can reduce the risk of heart disease events by 50 percent over five years.

“We know that a lot of people aren’t on medication and a lot of people aren’t on the best medication. That will contribute to death.”

Greenlane Cardiovascular Service cardiologist, Professor Ralph Stewart, said the study results are “staggering and the consequences substantial”.

The patient data analysed in the University of Auckland study suggests almost 7000 people have missed out on receiving the triple therapy medication between 2002 and 2015. The study did not include health outcomes for those people.

Heart disease is New Zealand’s second-biggest killer.

Establishing an individual’s cause of death due to incorrect medication was difficult, said Stewart, however, he had little doubt it was a factor in deaths.

“We know that a lot of people aren’t on medication and a lot of people aren’t on the best medication. That will contribute to death.”

People under 55, women, Māori, Pacific, Indian and Asian ethnic groups were most likely to have hospitalisation information missing from their GP’s records.

The study published in The New Zealand Medical Journal described the problem as a “classic ‘Swiss Cheese’ system failure” where patient information was lost at several stages in the process.

The study identifies several “recurrent error traps” where patient data falls through the cracks.

They include:

- hospital discharge information (which can be a fax, printed letter or pdf loaded to a portal) being sent to the wrong GP or practice;

- general practices not filing discharge information;

- data entry errors when manually entering discharge information into a patient’s electronic health record at a practice;

- issues transferring data between practices if a patient changes practices;

- patients hospitalised several years beforehand not recalling the event when asked for their medical history;

- incorrect data entry during assessments and practices;

- a 2013 Ministry of Health recommendation risk assessments could be “non face-to-face” meaning patients were not present to check that details used in the assessments were correct.

The results of the study were collated by using various databases, such as a heart disease prediction tool, hospital discharges and a pharmaceutical dispensing database.

Information scattered across various systems contributes to what the healthcare sector refers to as information chaos.

A possible solution to that chaos is a centralised database where patients' electronic health records could be accessed and updated by GPs and hospitals. This would mean GPs would immediately be able to see whether a patient had been discharged from hospital, and the transfer of patient data would be seamless between GPs.

The Ministry of Health developed an indicative business case for the introduction of electronic records. This was shared with Cabinet in December. A Ministry spokesperson told Newsroom the indicative business case is still “under consideration” by the Government.

Stewart said electronic health records would be a huge step forward.

“Information is really key to making the right health decisions and the electronic health record allows people to get the information that’s important much more reliably than they used to be able to.”

He suggested anybody concerned whether they are taking the best medication for their heart condition should talk to their doctor.

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