Real-time data is becoming the norm in everyday life. From instant mobile banking notifications, to live energy usage updates and ‘stream on demand’ films, waiting for information is fast going out of fashion. But we are not yet seeing the same advances in healthcare data. Cases where a GP entering patient data instantly appears in a national record, for example, are very few and far between. Progress is being made, however, and while real-time data may feel like the gold standard, healthcare demands a more nuanced approach.
Connecting a fragmented landscape
The NHS faces a unique technology challenge. Its complex structure of independent organisations has resulted in a complicated mix of technology and systems. These systems are often procured to resolve challenges within a certain area or discipline, with limited ability to talk to other technology, whether in the same organisation or another part of the health system.
Technology procurement is maturing, and every investment now includes a lot of scrutiny on how software and hardware will interoperate, with supporting health standards which are improving confidence in data security and information sharing. This isn’t a quick fix, however, and we remain reliant on ‘translator’ software to interpret data from one system to another, which can cause delays, often resulting in manual intervention which is both resource hungry and open to error.
Art of the possible
The Covid -19 pandemic demonstrated the value of timely data, not just in monitoring services but in enabling agile decision-making based on daily – sometimes hourly – information. Temporary powers suspending some of the barriers to data sharing gave us the chance to turn the art of the possible into delivery on the ground. This included a unique set of circumstances to enable effective monitoring of covid vaccine uptake, as well as centralised, prescriptive data capture of covid infections and deaths. These systems and processes enabled faster and more effective decisions to be made in allocating resources to tackle the spread of coronavirus. The challenge now is to use that learning in our ‘business as usual’ model to enable better care.
Integrated Care Boards (ICBs) are tasked with the achieving the Triple Aim of improving patient experience, population health and value for money. Data has a major role to play here as partners work together to use information to allocate resources, building on the learning from the pandemic. An early example is the setting up of System Control Centres to improve ambulance flows and access to emergency care which every ICB has been asked to do. Data flows into the control centres every 15 minutes, giving decision-makers the intelligence they need to understand capacity and resource pressures across the system and make fast, effective choices about where to treat patients.
Incorporating workforce data, such as sickness and absence, gives ICBs a clearer picture of overall resources. We know, for example, that reduced capacity in GP practices leads to extra pressure on NHS 111, walk-in centres and emergency departments, making live primary care workforce information vital in care planning. The data isn’t real-time but it’s timely enough to improve how resources are used to support better patient outcomes.
Quality over speed
Faster data flows have obvious benefits but better data quality is perhaps even more important. Currently, healthcare organisations provide data returns to help monitor and manage services regionally and nationally. But in some areas a single return requires several processes. A multi-trust system, for example, may be manually collating data on spreadsheets to enable that single return. Similarly, to coordinate a clinical team for theatre, individual assistants will be calling round trying to book times and fill the theatre schedule – a time intensive task. With patient waiting lists often disconnected from other data, patients may no longer be eligible by the time they’re called into clinic, leading to greater risk of wasted resources. We need to eliminate as much of this manual work as possible, while improving access to operational data which will drive more efficient ways of working. The technology exists to allow much of this to happen automatically but that means addressing data quality and governance, as well as interoperability.
A coordinated approach
NHS England is embarking on a major Federated Data Platform programme designed to address some of these issues by bringing together operational use and secondary use of data. It aims to provide the linking technology across different systems to support frequent automated data flows, which could ultimately pave the way to accessing real-time, or near real-time, information where there is a need to do so.
This project is not without challenges, particularly considering the major pressures on frontline services. But as we have learnt from the pandemic, data saves lives. Our understanding of how to use data to predict pressures, support preventative health and improve efficiency has improved exponentially. Real-time data may be the holy grail but there is still plenty to be gained from regular and accurate data flows that give a timely system-wide view of service priorities on the ground.
By David O’Callaghan, Chief Data Officer, NHS Arden & GEM CSU