Analytics 'crucial' in new commissioning environment
The ability to collect and analyse patient data and predict changes in demand for healthcare services at the earliest possible stage will be vital to ensuring the success of the new NHS operating environment, IT solutions experts have said.
With responsibility for planning and commissioning services switching to GP consortia as part of the Government’s health reforms, and a desire to create a more joined-up approach to the delivery of health and social care services, it will be increasingly important to have an overview of the population and their exact needs moving forward.
But, with primary care trusts (PCTs) and strategic health authorities (SHAs) soon to be axed, the challenge is exactly how the more localised clinical commissioning groups (CCGs) will monitor the needs of their patients and best plan for the future.
This dilemma has led to the launch of a number of informatics solutions as the industry designs programmes that will monitor the demographic and highlight areas where investment is needed and where money could be being wasted. This potential for savings will become a key driver in the current economic climate.
Paul Fitzsimmons, managing director of MedeAnalytics, explained: “Informatics is all about enabling fact-based decisions. CCGs are absolutely going to need information on which to plan spending and future services, and this does not have to mean huge individual investment.”
Instead, he advises, CCGs need to think of the process as being similar to the way golf clubs are run.
He said: “It’s is about consuming data as a group, but then driving that down to their own locality.
“Not every trust is going to need a massive data warehouse. Economies of scale can be achieved much like at a golf course, where you all pay a subscription fee which keeps the club running and the course up to standard, but then you take your own clubs and pay to play as and when you want to. You could also look at it like buying an apartment, where you again pay a set amount for the bricks and mortar, but then you can decorate and personalise your home as you want it.
“In the NHS we are going to need to be able to record and share information, but we don’t need the monolithic systems of old to do that. We need systems that talk to each other and that are information rich. These can cover larger areas, but with the ability to take local needs into consideration.”
Some forward-thinking NHS trusts are already exploring this challenge, including 13 PCTs and the regional SHA in the South West of England. They are using a MedeAnalytics system to aid with QIPP reporting, with the group collectively deciding on key performance indicators and defining the relevant business rules to be applied when creating these. The supplier then develops the associated analytics and reporting, which is available via the web to end users.
The reporting process is structured so that each PCT can quickly identify which indicators they are an outlier on, either locally or nationally, and drill down into their own practice and patient-level data to find the underlying causes. They can then use the system to run forecasts and set automatic threshold alerts to help them pro-actively manage or monitor their improvement or to disseminate the information to relevant stakeholders. The SHA, in turn, uses the system to track individual PCT performance and to agree remedial actions.
As well as tracking QIPP adherence, some trusts in the East of England have adapted the MedeAnalytics platform to support the new commissioning agenda.
In both cases the overall cost of the system is shared across all users under the pay-to-play principal.
And, at the Torbay Care Trust, the solution has been deployed to provide pathway analytics that examine health and social care processes for specific patient groups and at an individual level. The trust hopes this will enable a needs-based redesign of services and a significant reduction in duplication, as well as an improvement in patient care.
Trudy Corsellis, the trust’s head of business planning and performance, said: “In the Torbay region we have a higher than average elderly population when compared to national figures and this tends to create pressure on the local healthcare system due to that demographic group’s ongoing health and social care costs.
“As health and social care services are prescribed by various organisations throughout the region, we had an assumption that these services were potentially being duplicated for a number of these patients and that there must therefore be a better way of meeting the needs of those individuals more effectively.
“Through utilising MedeAnalytics’ solution, we will be able to uniquely map health and social care costs at a patient level; something that I believe has not been achieved elsewhere.
“With access to intelligent informatics in an intuitive visual display, we plan to analyse the complex groups of patients who receive multiple services to assess where there is a need for service redesign, with the intention of minimising needless repeat patient visits to hospital and to direct patients to the appropriate healthcare service in the community. For example, many of our elderly patients are at risk of falls and the care required following such an incident can become extremely costly to both health and social care services. By analysing the data within the analytics solution, we can work out how much this is currently costing each department and re-allocate costs for preventative measures.”
She added: “Transparent access to NHS costs viewable alongside social care costs will help us put into context the totality of services delivered to this complex group of patients. Analysing information in this way means we will be able to quickly look at how these costs can be moved around in the system in order to release financial savings, while improving the responsiveness and quality of patient care.
“The population as a whole is ageing and it is therefore paramount that we are able to understand how trends are changing. We are then able to plan our services and distribute our resources accordingly, helping give elderly patients a better quality of life.”
One barrier standing in the way of the more widespread adoption of this technology is the historic divide between users, in this case clinicians and healthcare managers, and the supplier base.
Fitzsimmons said: “The NHS has a legacy of a bunch of technology that is not joined up in a good way. The NHS National Programme for IT, while it did provide some good systems, on the whole just replaced big with bigger and this was not necessarily better. There have also been some technology companies who have been happy to put in expensive systems, then walk away from them. While some trusts have done a good job in adding the value they had hoped to gain, others have struggled and there has been a reluctance on the whole to let industry help.
“We need to start with a real honest discussion about what adds value and then we need to help the purchasers within healthcare trusts accept this. We need to sell the benefits to clinicians, rather than impose it.
“We need to show doctors that these systems are going to make their lives easier or we are never going to get their buy-in. The fear is that technology will take away their skills base and dictate the way they practice. We have to find ways of embracing how they work and how they want to work. As an industry, we need to ask clinicians what they need. We have some really forward-thinking people in the NHS and we need them to spread the word. The key will come when clinicians start to see others getting better outcomes from these technologies.”
Suppliers also need to play their part, he added. “We need to force vendors to make systems compatible and we are a long way from doing that, but it needs to happen.”