Big data means big opportunities

Tim Jones, the executive director of delivery at University Hospitals Birmingham (UHB) NHS Foundation Trust, crunches numbers with Ian Halstead.

Big Data is Big News … and Big Business too.

With the NHS under ever-increasing financial and demographic pressures, each NHS Trust and every hospital is desperate to drive greater efficiency into its operating model. For those that succeed, the rewards will be significant, especially if they can create their own digital platforms which are commercially attractive to others, and then use anonymised patient data to create revenue streams from pharma companies and elsewhere.

However, the same pressures which are the catalyst for change also mean immense workloads for those individuals tasked with delivering more from less. Fortunately for patients in Greater Birmingham, UHB has long been a national pioneer of big data and innovative strategic IT solutions.

Leading the trust on all things digital-and on just about every other aspect of its operations, including education, HR, organisational development, performance, research and strategy-is its executive director of delivery, Tim Jones. It’s a rather vague title, especially for someone who is anything but, as Jones makes clear with a precise and considered assessment of how the world of the NHS meets the new technological universe.

“Healthcare has been one of the slowest adopters of digital and big data, which is puzzling given the number of statistics and the amount of information it generates,” he admits.

“The biggest challenge was developing the right data platform, but we were very aware of what needed to be done, and developed our own system for prescribing drugs which gave us a huge advantage.

”Saying that, however much data you accumulate it’s not an end in itself, of course. The key is how you translate the data into meaningful actions and better outcomes for patients.”

The original platform was created at UHB-through collaboration between clinicians and academics-some 15 years ago-but Jones says the trust has been able to maintain its lead in the healthcare IT sector through constant innovation, and the willingness to commit significant human and financial resources.

“I suspect that most people outside the NHS aren’t aware of how much happens at major hospitals, just in terms of patient numbers and prescriptions,” says Jones.

“We have a phenomenal amount of data passing through our systems day-in and day-out. We issue something like 20,000 prescriptions every week, and deal with around 2,000 out-patients every day at the QE site.

“The vast majority of hospitals still use lots of different pieces of paper, with pens of different colour, and I really don’t know how they manage to cope.

“Since we rolled out our system across all areas of the hospital, it has become the bedrock of our clinical support system, and we’re always fine-tuning it to ensure that greater levels of efficiency are delivered.”

The QE only opened in 2010, meaning it had years of existing patient data from the previous QE which needed to be integrated into the IT system.

“We looked at different ways of efficiently accessing the old paper-based information. Back-scanning was considered, but the quality wouldn’t have been great and it would have cost between £1m and £2m,” says Jones.

“The best solution was to develop a clinical portal, which could store previous records, and also provide real-time access to current patient data.”

The new portal has subsequently generated huge benefits within the complex and lengthy training programme for junior doctors, although that wasn’t a catalyst for its development.

“There’s an enormous amount of detail about the way we work, about patients, about the hospital’s operational structure, and information about our systems and processes for them to acquire in their first twelve weeks,” says Jones.

“Our clinical portal monitors every patient, every drug and every dose, and we calculate that it prevents around 20,000 errors by junior doctors in prescribing every year. Mostly, they’re very small errors, but it’s reassuring to know that the portal is there as a back-up.

“We have built-in a system of ‘nudges’ and checks for patient protection, to ensure the correct drug is always given in the correct amount for the right condition or illness. If someone tried, for example, to prescribe too much of a certain drug, or to the wrong patient, the system would simply refuse to accept the instruction.”

The clinical portal and its prescription system have also created remarkable improvements in the speed at which tests and processes can be carried out.

“We looked at the data for infection control, when checks were being made for the possible presence of the MRSA bug, before ‘decolonisation’ could be carried out, and it was taking 48 hours for the results to get back from the lab to the ward,” admits Jones.

“We were able to automate the process, and now the delay is just five seconds. Nurses can carry out the tests, and then administer the drugs (if required) immediately. We’ve also been able to sharply reduce the amount of drugs being prescribed-but then not used in full.

“The typical figure for any NHS hospital is around 20%, but by more precise monitoring and checks, we’ve got that down to around 10% and 11%.

“There’s always going to be an element of wastage when prescriptions are being issued, because it’s impossible to predict exactly how much of each drug will be needed, but I think we can get the figure down to between 5% and 6%, which would be a massive cost benefit for us.

”By crunching all the data, we can also now take real-time action about the level of drugs which are available. If, for one example, one ward is running low, then the system will inform the staff.

“It’s not just about being more efficient, delivering better outcomes for the patients, and reducing our drugs’ bill though, we also see this process as an integral element of the training process, as it does make the junior doctors more aware.”

However, Jones is concerned that many manufacturers of medical devices have not yet tweaked their business models, to take full advantage of their technological innovations.

“The use of ‘wearables’ hasn’t taken off as expected, largely because the industry has failed to realise that the value is in the data, not the device itself,” he says.

“It would be useful to have all this automated data, but staff still need to visit patients and talk to them. We have around a million patients a year, so the cost per unit is prohibitive. If hospitals have to pay £50 per unit for each patient, no-one can afford it.

“The traditional model, of recouping R&D costs in the first year or two, just doesn’t work. Manufacturers need to engage more with clinicians and much earlier. Perhaps they could also look at partnership models with hospitals, because the current strategy by the device makers isn’t helping them, the NHS or the patients.”