Population health data system working behind the scenes on the Events Research Programme in Liverpool.
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Solutions
Over 17m citizens benefit from targeted care using our population health management tools. In partnership with our ICS partners, we are leading the way in data-rich population health intelligence that provides actionable insights for the reset, recovery, resilience and continuous improvement of health and care economies.
Our population health management system uses integrated health and social care data held in our shared care record to produce richer insights at population, place, cohort and individual level. Insights that are driving actions such as identifying and enrolling individuals onto acute and chronic disease remote monitoring programmes. Enabling clinicians to drill through to the integrated personal health record. Analytical tools are used to evaluate and measure the impact of interventions on patient engagement, compliance to treatment targets, behaviour and disease control. Insight can be presented back into an integrated record, closing the loop and enabling clinicians to use insight to take action through a 360-degree seamless, integrated solution.
The data intelligence generated by the population health platform is used to drive actions. This includes planning services such as working out what is needed, predicting when and where a surge in demand will likely come from and putting appropriate measures in place.
The platform enables evaluation and provides learning to support continuous improvement and best practices through the ability to study the impact of interventions.
It empowers Integrated Care Systems to develop their own analytical eco-systems by providing a configurable platform which enables homegrown analytics, importing local data sets and the opportunity to share and collaborate with colleagues in other areas. Using shared care and personal health record data intelligently, integrated care systems will operate more agilely, adapting and scaling up new services as demands change.
Combined Intelligence for Population Health Action (CIPHA) programme.
The NHS CIPHA programme supported health and care systems across the country to develop their population’s health analytics use by providing a population health platform, analytical insights, and the opportunity to collaborate and share best practice across different geographies. The programme aimed to support Integrated care systems to develop the governance needed to embed the use of population analytics within the culture of an ICS. The expansion programme, run across a population of 15 million citizens, was based on the original CIPHA programme developed by Cheshire and Merseyside in response to the Covid Pandemic in the summer of 2020.
CIPHA analytics uses a combination of local and national data feeds, made available in the Graphnet population health platform, with real-time analytics and dashboards presenting information to allow prompt, coordinated actions at both local and regional levels.
Alongside Covid analytics, virtual monitoring, mental health, equity analysis and elective recovery were key analytics shared across the partner organisations. Academic research was also enabled through the use of trusted research environments.
We have been working with Frimley Health and Care ICS to identify patients that would benefit from remote monitoring at home.
Patient groups can now be filtered interactively to identify and highlight cohorts to be monitored more closely i.e. Covid patients, those at risk from Covid, or those with other health conditions who might need flagging and monitoring through programmes such as Pulse Oximetry @Home.
Findings from 11 Nov 2020 to 27 Feb 2021 (108 day period):
Population health data system working behind the scenes on the Events Research Programme in Liverpool.
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Being development partners with Graphnet and using their population analytics platform has really enabled us to build the supporting analytics that enable our move towards developing a mature population health Intelligence system.
Mark Sellman – CIO Frimley Health and Care ICS & Connected Care
Population health – providing actionable insights
The need for population health management systems has never been more important as we move ahead into restoring services, reducing backlogs and identifying unmet need – all while tackling inequalities in access, experience and outcomes.