It is accepted that the business intelligence generated from healthcare data can be used to improve the quality, safety and efficiency of patient care.
It is accepted that the business intelligence generated from healthcare data can be used to improve the quality, safety and efficiency of patient care. There are certain challenges to be overcome first, however, according to HSE Chief Information Officer Richard Corbridge.
“Getting from data to information is our focus at the moment”, Corbridge says. “We have an awful lot of data but we are not very good at turning it into information and that means we can’t get at insights from the data collected. However, this is common to health services everywhere. Their job is to deliver a health service not collect data. The question is how we get better at the collection and delivery of information. We know we collect lots of data through various systems but we struggle to make it useful after that.”
One of the issues is the absence of an overall national approach. “We don’t have a national system for data collection”, he points out. “In many cases data is recorded using pen and paper, in others it is kept on Excel spreadsheets, and there are many other systems as well. We are now looking at the wider standardisation of data collection through improved governance and the implementation of a data dictionary.”
In Ireland that standardisation begins at a very basic level and a data dictionary is being compiled within the HSE to ensure that there is common terminology used throughout the service. “We need to ensure that we are talking about the same things and counting apples and not oranges”, Corbridge explains. “What is an admission, for example? We have to define an admission so that we have a common understanding of it. In one hospital it can be one thing and in another something slightly different – it changes how things are counted.”
The well-covered trolley count is a case in point. The fact that there can be differences of opinion on the totals indicates the need not only for standard definitions but also for reliable data collection and processing systems.
According to Corbridge, the easiest way to do a trolley count at the moment is for a hospital Chief Executive to telephone the emergency department (ED) and ask for a physical count of the number of people on trolleys at the time. There is no IT system to handle the task in real time at present.
"Real time data is what is needed”, he says. “The biggest benefit this can bring to a health service is the ability to look at everything that’s happening at any one time. That’s how you make it more efficient. But a lot of health
systemsdon’t use standardised forms and reports. They are collecting a lot of data but there is no real value being extracted from it.”
Corbridge says the first challenge is to collect the data at speed and to a standard that can be used across the whole health service. One solution which is about to be deployed is mobile. “This will enable people to use mobile devices to collect and update data on patients in EDs”, he says. “This replaces pen and paper systems and Excel spreadsheets. It is uploaded in real time and where there is a patient administration system (PAS) in place it will provide real time information on what is happening. It means the data is constantly updated and this allows the service to respond to changes as they happen.”
The goal is to put the patient at the centre of any new systems put in place. With this in mind, electronic patient records (EPRs) are being set up for epilepsy patients across Ireland. The secure web-based EPR facilitates the
sharing of clinical information across the entire health service regardless of traditional organisational boundaries or geographical location. Authorised clinicians and other professionals involved in the care of the patients can
access the records.
The Epilepsy EPR will become the repository for healthcare records for all 40,000 people with epilepsy in Ireland. While the EPR offers significant advantages to patients it will also have epidemiological benefits. Large volumes of anonymised data can be analysed to improve the overall care of epilepsy patients throughout the country and to make the national epilepsy programme more effective.
An example of data analysis at work in this area is a project to sequence the genome of 1,000 under-5s with suspected epilepsy. “The information we gather through this project could save up to 90 lives a year – that’s a great example of big data in action”, says Corbridge. It is hoped that patients will ultimately own their records and be able to update them themselves. “The key around big data is that when you have quicker access to data and use it to make the service more efficient, we must then put the patient at the centre of everything we do”, Corbridge points out, nothing that “the EPR will enable proper joined up care for patients.”
At first glance it might appear that recording data on new devices and systems might place an additional workload on clinicians, Corbridge believes the benefits far outweigh this. “Clinicians are happy to participate in EPRs if they
get something out of it. We are not doing this just to monitor what’s happening. We will use the data for secondary purposes such as making the system more efficient and for population health – this will benefit everyone involved including patients and clinicians.”
Another step forward is in the form of the new Individual Health Identifier (IHI) system, which will see everyone in the country issued with a unique, lifetime number to track patients through the various health and social care
services. Its purpose is to accurately identify the individual, enabling health and social care to be delivered to the right patient, in the right place and at the right time.
In parallel, health identifiers are being assigned to healthcare professionals and organisations to identify the practitioners who provide health services such as hospital and GPs and the locations where the services are
provided. This will provide fast, accurate information on a patient’s interactions with the health service regardless of health provider or location.
The ultimate goal of the identifiers is better quality and safer care. They are also seen as the cornerstone of e-health systems and are critical to the implementation of EPRs and other e-health solutions such as e-prescribing. These systems have the potential to greatly improve patient safety by improving the sharing of healthcare information between healthcare practitioners. By uniquely identifying service users, it is possible to reduce the number of adverse events that may occur, such as giving the patient incorrect medication or vaccinations, or admitting an incorrect patient for surgery. The use of health identifiers will also reduce duplication and administration work, making them both time and cost effective.
Most importantly, they are separate to an individual’s PPS number which goes some way to ensuring patient privacy and confidentiality.
“The HSE has built the infrastructure required to deliver the individual health identifiers at a national level. Creating the Individual Health Identifiers is a step towards to bringing real benefits to clinical practice as a result of access to information. As well as the health identifiers we hope to have the national EHR system up and running by the end of 2019 but if you go to Temple Street Children’s Hospital or St. James’s Hospital today you can see them
in action already. These are really good examples of how they work for the benefit of patients and help improve quality of care.”
Overall, Corbridge sees big data and the analytics of data playing a major role in improving the health service in the coming years. “Big data can help greatly with capacity issues, for example. If one ED is full you can redirect ambulances and patients to another in advance. We can use it to match capacity more closely to demand so that services are available where they are most needed now and in the future. We need to get better at using the data for things like that. It is also a very powerful decision tool and we can use it to model decisions that you just can’t and shouldn’t do by trial and error.”
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