Paul Henderson, Head of Health Analytics, KPMG UK explains how health analytics can be used to create a better, more efficient health service with better patient outcomes and a healthier population overall.
Paul Henderson is Health Analytics Solutions Director with KPMG. He splits his time between Dublin and London and has particular expertise in using data and analytics to improve the UK NHS. He believes lessons can be learned from that experience, here in Ireland.
NHS England recently published a 5 Year Forward View that highlighted a set of challenges that the NHS would need to address. The document brings together the collective experience of professionals throughout the health, well-being and care management community, to produce a consistent view of what needs to be done by commissioners, providers and those involved in strategy and policy. A desire to improve population health is a key goal in helping manage the demand on pressured services and improve the health of the nation in general.
Henderson recognises the part that data and analytics will play in modelling population health to predict and manage demand, which is a universal problem that impacts on us here in Ireland, as much as it does the UK. The NHS’ funding pressures are well documented, however he feels that “You can’t simply continue to increase funding without trying to manage demand. In particular, Commissioners face a number of challenges, such as managing demand now and in the future and it is great to see NHS England working that problem through with a prominent focus on population health analytics.”
Demand for services is complex. In the UK many agencies provide many types of services in many ways so getting a consistent view of demand can be difficult. However modelling is possible and can help service commissioners and providers alike proactively manage the problem.
“There is a science to that”, says Henderson. “When we think about this in KPMG we look at who has demanded services historically and then look at their behaviours, their backgrounds, where they live, where they shop, if they exercise, how they engage with social media; all the things that retailers would look at when they are deciding where to open a new shop, for example. One of the key areas where analytics can help improve health services is demand prediction and management. “You look at the population, find the people who are using services, predict their behaviours, and attempt to predict how they are going to use services in future.
”A challenge in gaining this insight into likely demand is then understanding how the healthcare system can use that data to drive change. Data is at the heart of the reform agenda in the UK, however it must be used to be truly effective.
“You can use very sophisticated analytics to improve the cost effectiveness of the service and to engage proactively with patients in order to get the positive outcomes we are all looking for”, he adds.
He cites the example of child vaccination. “Prevention is clearly important and so measures like improving the way we vaccinate our children can help. Of course, you have to find the children and they can be dispersed very widely around the country; you have to develop a vaccination programme and you can risk stratify to identify hard to reach groups of people. If you don’t do this you are storing up problems for the future. The expenditure and resources devoted to the vaccination programme are small in scale compared to the long term costs of not vaccinating and the consequent future burden on the health service.
The same data and analytics that help identify epidemiological issues in parts of our population can be used to identify cohorts of actual and potential patients and enrol them into vaccination programmes.
Of course delivering efficiency gains in the health services is still top of mind for most Chief Executives. The UK health service faces a challenge in the form of its government mandated deficit reduction programme. “You can save money in a number of ways”, Henderson notes. “You can become more efficient at what you are doing. Some of this has already been done and there is more to do. You can stop providing some services but that needs to be done carefully to avoid generating more issues than it solves.
The other way is to improve the overall health of the population and there are some really interesting innovations happening in that area.” Examples included primary care services embedding the use of equipment like digital
scales and electronic blood pressure cuffs into the core clinical process of providing homecare for the elderly. “The GP gets the information and can monitor the patients’ health status. It also helps people to take responsibility for their own health and wellbeing. You can’t just tell people to take responsibility, you’ve got to engage with them, encourage them, and give them the tools to do it.”
This is a good example of modern technology-driven trends such as telemedicine finally landing service benefits and savings as a result of appropriate adoption. “This is not about giving Fitbits to the worried well”, Henderson says. “If you give people the technology that will keep them out of hospitals or care homes and allow them to live independently, or with support in their own home, then everyone wins.”
With an ever increasing number of data sources comes the challenge of being able to see the wood for the trees. Henderson remains hopeful and believes the health services have a growing amount of the right resources to deal with this issue. “There are people with statistical capability in the health services, but there is a need to align them with the problems faced by the system. We need to get the CEOs to talk to the statisticians. This will only happen when the statistics are of proven value in solving the issues that the CEO faces.”
The value of effective data as a key enabler of change is being promoted by a number of communities of professionals in the UK. For example, one profound difference between the UK and Irish health services is the role of Primary Care professionals in the commissioning process. GPs are leads of the clinical commissioning groups (CCGs) that are responsible for a local population. Visits to EDs, therefore, by their patients are paid for out of their budget. GPs therefore have two main interests in reducing these visits – the first is to improve the quality of care and health outcomes for their patients and the second is to ensure that their budgets are not used up by unnecessary ED visits. Effective data is key to understanding whether these interests are being satisfied. Henderson notes a story of a GP he has worked with in the UK. “If you are a GP and can predict which of your patients are likely to go to ED as a result of their asthma you could get a district nurse aligned to the practice with a specialism in asthma. If you couple that with some health promotion work and then monitor the people who go to ED and follow them up to find out why you can help them avoid future visits. Frequently, their issue has been poor understanding of how to use their medication and that can be easily dealt with by a nurse specialist..” Another area where analytics can come into play is improving the performance of the health service organisationally. “One of the things we need to pay attention to is our ability to staff the health service.
We use what we term decision science to help. We are using this to improve the way organisations work and deploy the most capable and best aligned people at the appropriate levels. Those organisations perform better because they are managed better, for example they enable people with transformative capabilities to do their jobs.”
Decision science is a relatively new discipline. It involves using a wider and deeper range of data sets to think around a problem and using data science to build predictive models. In this case the science is looking at a range of factors which affect staff performance, not just the conventional metrics like vacancies and turnover rates but also workload, attitudes to work and spatial data about surroundings and relationships with colleagues. Henderson believes that, “These new insights into, for example, population health and patient and staff behaviour will help us manage service pressures and give us the best chance of responding to the demand for a 21st Century set of global health systems that are key to enabling us all to live longer and healthier lives.”
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