MARLOW, UK - (HealthTech Wire/ Opinion by David Downing) - In light of the government’s recent commitments to use technology to enhance the effectiveness of the NHS, it is timely to look at the benefits of unlocking patient data and the lessons we could learn from experiences in other countries.
It might be a little late to come the big data party, but it seems that after much gesturing and industry drum-banging, the government is finally waking up to the opportunities for improvement offered by technology, including big data analytics. Last month, UK Health Secretary Jeremy Hunt delivered what he called a “historic” first mandate from the government to the NHS Commissioning Board, setting out exactly what every patient in England should expect from the NHS over the next two years. This includes a range of new measures to improve patient care and experience in the NHS. At its heart, Hunt highlighted the pivotal role that technology would play in ensuring the mandate’s targets are met — these include cutting premature deaths, better help for dementia sufferers and developing a clear strategy for a single integrated electronic record, covering all patient interactions with health and social care.
This is not the first time in recent months we have heard the government talking about the potential for technology to address inefficiencies and improve service provision across the NHS. Only last month, Prime Minister David Cameron committed to invest £100m in technology to relieve nurses and midwives of unnecessary paperwork. The aim was to reduce the administrative burden on health practitioners whose time would be better spent caring for patients rather than completing hard-copy forms.
You certainly can’t fault the intention. Technology has huge potential to relieve the burden on the NHS, particularly in the creation of a single integrated patient records database. Earlier this year, a report by the Centre for Economics and Business Research (Cebr) highlighted that healthcare IT systems which efficiently communicate and integrate patient data across departments and institutions, while retaining privacy controls, could significantly improve efficiency and quality of care. According to that report, not only would such systems have a significant impact upon the way that frontline care is administered across the health service, but by unlocking the value from its big data, the NHS could also generate savings of nearly £2billion.
Curbing the demand for acute care
As we all know, the pressure on the public sector to make savings is fierce. The NHS costs UK taxpayers over £100 billion annually, and this figure continues to grow year on year. The reality is that healthcare, and the provision of acute care in particular, is expensive, and the NHS faces a severe challenge to its ability to provide care if it does not curb the demand. It has long been recognised that early medical intervention not only significantly improves patient wellbeing and survival rates, but also greatly reduces the burden on health authorities and therefore the taxpayer. Identifying diseases and long-term illnesses early on makes them considerably easier and thus less costly to treat.
Much of the current problem, however, centres on the fact that for too many patients until they walk into A&E the health service has very little knowledge about their condition. For example, if people are reluctant to see their GP before their situation becomes serious they may have undiagnosed conditions, or key information relating to their medical history available elsewhere may not be shared within the NHS. This is where a single view of the patient covering all patient interactions with health and social care would be invaluable. In order to be able to target and support high-risk patients, the NHS needs access to reliable, up-to-date information on patients and citizens, including relevant data from external sources such as local authorities.
Make use of the data
A single view of the patient is really just the starting point. The government needs to take the initiative one step further if it truly wants to capitalise on the opportunity big data analytics offers the NHS and wider health service network. The questions that really need addressing are: what do healthcare bodies then do with that data, how do they derive insight from it and most importantly, how do they actually marry it to a single view of the patient by incorporating multiple systems?
Only by answering these questions will the NHS be able to make better and predictive fact-based decisions, such as who to target for early interventions to prevent them becoming more ill, perhaps by putting them on a structured programme; or how to prevent someone repeatedly having unplanned hospital stays, through targeting community nursing and other near-to-home resources.
Making better healthcare decisions, faster
Research shows that unstructured data, such as the anecdotal note-taking which occurs when recoding a patient’s symptoms and medical history, can be as valuable as structured data that has been entered into pre-scripted fields, when it comes to diagnosis and predictions. Putting words on a form or asking a patient to select an option from a specific list puts health officials at risk of losing the true meaning of the information being recorded. After all, the world is not black and white but many shades of grey and without context words can be misinterpreted. When it comes to forming a diagnosis on a critically ill patient the consequences of a misdiagnosis could be life threatening.
If it is to reap the full benefits of its data, the NHS will need to consider how to pull out this text, make sense from it and deliver the insights to clinicians in a format that will empower them to make better decisions faster. The Department of Orthopaedic Surgery at Denmark's Lillebælt Hospital recently did just this, ending resource-intensive, manual journal audits and replacing them with an IT solution that provides quality control of registrations in all patient records. The department has implemented a system that automatically analyses the records of all hospitalised patients with a text analytics solution. The software analyses the surgeon’s dictation in the patient record and automatically registers the code that is connected to the diagnosis and the treatment. Some adaptation has even been required to ensure that both Danish and Latin terms, and abbreviations, are interpreted correctly. This is just one example that the NHS and wider UK health sector could benefit from.
The UK government’s plans also include giving citizens access to detailed information on the survival rates and success of treatments in their areas, so they can choose to go to better performing hospitals or doctors if they wish. An analogy can be drawn here with healthcare reform in the United States, which included a series of quality initiatives aimed at measuring, tracking and improving the quality of care delivered by privately operated Medicare Advantage plans. Based on their ability to improve the quality of care delivered to their members, health plans have the opportunity to obtain quality bonuses.
To help US health plans meet the federal government’s quality of care targets, as well as qualify for Medicare incentives one company has used analytics to help clients track their performance against quality-of-care metrics. It uses a business intelligence system to provide up-to-date data on quality metrics (eg percentage of women receiving mammograms), allowing clients to easily access their data to monitor their progress and to implement any changes needed to improve performance.
By gathering claims data, survey data and medical record review data, the system delivers reports through a web portal so users can drill down to the plan, provider and member level. A complete medical management platform uses predictive analytics to identify specific factors such as avoidable hospitalisations and emergency room encounters and helps to achieve cost savings through better preventative care.
The system, which can be accessed through smartphones and handheld devices, allows providers to easily review current patient information before going into an examination room. They can look at preventative measures that the patient might need, as well as patient utilisation of services that may not be in the doctor’s medical records — they can see more of the patient’s history by looking across the providers that the member has seen in the past.
In the future, the company plans to add more predictive analytics to the system to forecast potential high-cost patient cases, with outcome variables like the risk of future hospitalisation. This will help health plans, for example, reach out to female members who have a low probability of proactively scheduling their own examinations, based on their prior care histories.
While recent announcements show that the government is waking up to the potential benefits of big data, it is still some way off reaping the full benefits. The government's commitment to technology is there for the NHS to exploit. What’s important is for the NHS to understand exactly how it can work and learn from examples like those described above that have already been established in other countries. With a huge amount of patient data at its fingertips, the NHS has a real opportunity to use available data to help health professionals and clinicians make better evidence-based decisions, innovate in the way it works, improve the level of service while also cutting costs and so deliver better value for money.
Source: HealthTech Wire
David Downing is healthcare specialist, SAS UK & Ireland
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