Population health management is the next big thing – there is no doubt this discipline will be key to a sustainable NHS. But are we really in a position to reap the benefits when the NHS is still so digitally immature? There are opportunities to be had, but how do we work together to deliver the potential, without crushing the dream? Gareth Dellenty considers the issues.
We live in exciting times. Digital technology and the data driven nature of business is creating new products and services that anticipate and match our individual needs. The next industrial revolution is coming, and data is the new steel.
For the NHS, one of the greatest opportunities of this revolution lies in population health management – a discipline that enables the identification and management of high-cost, high-need population cohorts, and supports a preventative healthcare agenda. Underpinned by population health analytics, we will find the missing million, the frequent flyers, the outliers. We will design and deploy innovative packages of care and deliver them through an augmented workforce of technology-savvy clinicians and AI algorithms. Well, that’s the dream…
However, we urgently need a sensible conversation about the practicalities of deploying such technology and leveraging value from a big data platform.
For population health analytics to deliver value, comprehensive patient records are needed, incorporating information from GPs, local authorities, community, mental health and acute trusts, among others. These records must ‘talk the same language’ and contain the clinical depth to support analysis.
Like it or not, in the majority of NHS trusts, much of the clinical record is on a tree-based storage platform. Many providers are still using paper or are digitising paper records or producing un-coded, free text notes, limiting the potential for analysis. Despite pockets of investment, overall digital maturity across the provider sector remains low.
While there have been promising moves towards the introduction of electronic patient records (EPR), many solutions have been deployed on a like-for-like basis, where process re-engineering, dataset design and change management is minimal. This results in a less clinically detailed dataset, and often means providers do not realise the benefits of the systems they implement. Broader data collection is still geared around statutory returns and contractual information, which further limits its usefulness.
Additionally, underinvestment in business intelligence (BI) means many trusts still struggle to produce statutory returns for national and local bodies, and have not yet had the chance to develop a true analytical capability. There is little standardisation in BI systems across the NHS and a prolific number of home-grown solutions.
These challenges limit opportunities for NHS providers to leverage benefits from the data they generate and may impact the population health agenda.
How to move forward
There are ways to ensure the NHS is well placed to realise the benefits from population health and wider digital innovation, including:
- Expediting investment in provider digital maturity, further embedding of EPR solutions and the complete elimination of paper (including electronic versions of it).
- Embarking on a nationwide programme to identify best practice and new solutions to develop BI capabilities.
- Developing a model for assessing the quality and value of clinical datasets for population health projects, covering completeness, lineage, clinical content and coding depth.
- Building the analytics capability needed to leverage population health solutions through a national data science recruitment scheme, alongside a development programme to help managers and clinicians get the best from the data they generate.
- Changing the technology-driven nature of these projects to include more clinicians in the process of defining use cases, hypothesis, datasets and protocols of use for population health platforms. Ultimately, it is clinicians who will extract value from these solutions and react accordingly.
At a local level, we should avoid jumping into the population health analytics pool before checking the temperature! Smaller scale analytics projects may be the best way to develop the capabilities needed to make future population health analytics initiatives a success.
For example, undertaking incremental projects to build disease or pathway specific datasets and analysis projects will give a group of organisations a measured understanding of its data quality, completeness and value. It will support the building of data science, analytical skills and create opportunities to involve clinicians in data projects, before being rolled into larger population health initiatives.
Proceed with caution
Population health analytics platforms are going to be a key tool in securing the future of the NHS. But there is a significant risk that NHS time and public money could be wasted on well-intentioned platforms that don’t deliver a genuine shift in approach, unless we improve overall digital maturity, plug the skills gaps and engage with organisations to navigate the path to better processes and systems.
It was encouraging to hear the new Secretary of State, Matt Hancock MP, setting out a comprehensive and well-rounded digital health agenda last week (6 September), and it is incumbent on us all to play our part in overcoming the challenges so we can realise the anticipated benefits of new technology for the NHS.
The new industrial revolution is coming – let’s make sure our steel is resilient enough for the job.
Gareth Dellenty is a consulting partner at Channel 3 Consulting. Follow the organisation on Twitter @channel3group
Channel 3 Consulting is an NHS Confederation associate. Find out more about our associates scheme, a dedicated programme for organisations that work with and supply services to the NHS.