Business Intelligence (BI) is a hugely useful way of analysing data to discover ways of improving business performance. Using web-based BI the NHS is reaping benefits too.
Modernisation in the NHS is a slow and complex task. Quite apart from all the cultural, political and economic issues involved, there is the struggle with the best way to deal with legacy data and information the NHS has built up in its long history. Data complexities faced by BI include the vast difference in formats between clinical data and managerial data.
There are issues around the varied collection of IT systems and arrangements the NHS deals with, the National programme for IT being the latest, and in addition some data is not even held by the NHS but is the property of affiliated institutions, Royal Colleges or other professional bodies for example. Finally, many NHS systems are still using green-screen, client/server technology, which is not connected to the internet, and as a result are isolated 'islands of information'.
BI can start unlocking the hidden value in NHS information and start providing clinicians, administrators and commissioners much more powerful ways of seeing the bigger picture in their organisations or networks. BI could, for instance, facilitate benchmarking around incidence, mortality, quality performance measures and access targets for different disease areas, among other factors, in a way that is accessible and aggregated on a single website.
The Cancer Commissioning Toolkit (CCT) is a web-based BI tool that is providing an online, national view of responses and actions to cancer. The main impetus behind the CCT was the need to help cancer networks and primary care trusts commission cancer services more effectively, addressing the government's vision for ‘World Class Commissioning' (Commissioning is the NHS term for planning and purchasing healthcare).
CCT is a one stop library of cancer information and data, and has been hailed as "a major step forward" by the government Cancer Tsar Mike Richards. The toolkit presents data in a way stake-holders can understand - and data can still be made available remotely to relevant stake-holders despite not being physically contained in some proprietary NHS database.
CCT also points to the way lots of key information resources can be easily grouped and accessed, via portals that can, when used effectively, transform the way the NHS can deliver information, driving management information to individual user desktops where it can easily be integrated with familiar Microsoft Office tools such as Word and Excel. As stake-holders already use these tools, the integration and deployment overheads are radically small. As a result, processes and decisions are much more transparent to stake-holders from different sectors.
One of the key features of the CCT is that the toolkit is designed around the patient's pathway or journey through treatment. So for each aspect of the patient's journey, there is a chapter, which has a number of sections identifying metrics for each of those areas. That means that, at a glance, managers can get an overview of cancer services for each stage of the patient journey.
The ability for a Cancer Network or NHS Trust to benchmark its performance against national or similar regional characteristics will also be extremely important as a driver for improved quality across the service.
Another valuable BI methodology featured in this system but easily incorporated in the other systems is the browser like dashboard, which allows an at-a-glance view of overall performance at either a Network or PCT level. The dashboard is a great way to present data in a way that stake-holders can quickly grasp and then make practical use of. Clinicians are now more likely to co-operate in ensuring their element of BI is iteratively updated and refined electronically year-on-year.
This system is in my view a real pathfinder example of what can be achieved in the NHS with good BI. The NHS needs to look to see how this sort of effective, 21st century BI signalled by things like CCT can start to help meet the challenges of healthcare in today's world and society.
The NHS could look to deploy CCTs in many areas of its service delivery. This is also about the implementation approach, as much as the technology. We should start with an incremental approach, based on clearly realisable short term wins - starting small adding more advanced features as the need is defined, based on usability testing and user feedback - and when your people are ready to progress to the next stage. That will help deliver consistent project success. Also core to this approach are "train the trainer" sessions and regional roll-out events to promote take-up.
In contrast, to all too many NHS IT projects, CCT is a reliable end product that was delivered on time. CCT involved a partnership between pharmaceutical companies, the Department of Health and the IT sector, and this unprecedented level of cooperation in NHS IT has been cited as another important ingredient in the project's success.
Web-based collaborative technology may be a fresh approach for the NHS, but the success of CCT suggests that national, high-level approaches, using web-based BI, may be useful for Commissioning and Programme Commissioning of other long-term conditions like Circulatory, Respiratory, Renal/Hepatic
diseases, Neurological conditions, and Mental Health - and that could
just be the start.
After all, the Government's vision for world-class Programme Commissioning makes sense to most clinicians. Commissioners will be expected to have in place structures which facilitate clinical advice and to share data with clinicians in a form they understand. That's why focused and useful BI implemented in a way that is service and user-led is what the NHS may need above any mega-projects.
About the author:
Dr Roger James (pictured below) is a part time NHS Consultant in Oncology. He has over ten years experience in senior NHS management at both Clinical and Medical Director level. He was a member of the Steering Committee for the National POI Capacity/Demand Project and chaired a national Joint Collegiate working party on the commissioning of cancer facilities. He is national principal investigator of the largest world-wide trials of chemo-radiotherapy for Anal Cancer and Intra-Hepatic Chemotherapy.