29 January 2021
by Dr Ian Denley, chairman of Graphnet and joint CEO of the System C & Graphnet Care Alliance
The use of data in understanding and responding to Covid-19 has given us a glimpse of a transformed future. Much has already been learnt about the value of accurate information during the pandemic. Less widely discussed is the part data-sharing is already starting to play in unlocking the transformation that the health care system is looking for so keenly.
Already we can see real examples of where data is making a difference to the way the health and care system operates. In the scramble to deliver Covid oximetry at home, care communities with shared care records have been at a distinct advantage. They are able to link Covid test results with known diagnoses, age, ethnicity and location in order to proactively identify which patients are at increased risk of a severe outcome and are suitable for remote pulse oximetry monitoring. This is a much more nuanced and helpful approach than relying on manual identification or the shielded patients list and allows much more effective targeting of resources.
Further, acute and community data highlights those patients who have been admitted, so time is not wasted trying to enrol them on a virtual ward programme. Local systems are now looking at hospital discharge processes, and the contribution that remote monitoring for recovering Covid patients could make to freeing beds as quickly and as safely as possible.
In Cheshire and Merseyside, the care system has set up a population health management system to inform its response to the Covid-19 pandemic, and this is being used across the geography for a wide range of uses affecting all parts of the care system – including management of the Liverpool mass testing pilot, population level planning, demand prediction, coordinating the vaccination programme and the targeting of direct care interventions – such as providing acute staff with Covid test history reports so they are able to check patients’ status when admitting or booking elective surgery.
A population health management system means local areas are able to use case-matching to identify patients for intervention using a wide variety of criteria – offering support to those with mental health difficulties, for example, or those who might be suffering due to the consequences of delayed elective activity. They can use the service to assess where Covid vaccine take-up is low, in some cases engaging local religious leaders or extra translation services to support messaging, and helping inform where to focus call and recall efforts.
In all these cases, record sharing is used for direct care and is used locally, and this means the quality and completeness of that data is consistently enhanced. It is then pseudonymised and anonymised for use in analysis, informing planning and decision-making. It is a virtuous circle.
Already, there is evidence of a shared drive and purpose where this quantity and quality of real-time and near real-time data is available to a care system. The data is accelerating the process of collaboration, creativity and innovation and providing an incentive for cross-system working that has traditionally been very difficult to forge.
With the legacy of the technical infrastructure and analytical tools in place, there will come a time soon when the NHS can focus on and support other groups of patients using case-finding, remote monitoring and targeted interventions - those with asthma, diabetes, heart disease or mental health problems are good examples. The combination of a country-wide network of Integrated Care Systems with shared care records and population health management platforms is going to be a powerful and positive legacy of Covid-19 if those systems have a common purpose around their shared data and put it to good use.