Harnessing data to improve patient pathways

As chief information officer of Yorkshire Ambulance Service Trust, Simon Marsh is used to serious restrictions in his and his colleagues’ ability to access data.

“When we transport somebody to a hospital we have been responsible for their healthcare from the initial call all the way up to dropping them off at the hospital,” says Mr Marsh.

“But we haven’t got a clue what happens to those individuals once they’ve been through the hospital system. We don’t know if somebody’s in there for an hour, two hours, what the eventual outcome was, because of the data protection and the information governance issues that exist between the various NHS environments.”

Mr Marsh was speaking at a recent HSJ virtual roundtable, convened to consider how patient pathways can be improved and silos addressed. And his reflections perfectly illustrated the nature and scale of the problem the NHS will need to overcome.

“Data is key to all of this,” he argued. “Unless we’ve got data in the right place we’re not going to break down organisational or system silos in the way we need to. We just require information at the point of contact and then further information once we’ve discharged a patient from our care into somewhere else.”

Shared care records

One possible way of doing so may be a shared care record setup. According to Bruce Horne, a product specialist lead at Orion Health, interest in such systems has increased in recent months.

“With some of the shared care records we provide for our clinical portal we’ve seen significant uptick in the amount of licences that have been requested, especially after the arrival of covid in the spring.”

But he argued that, for pathways to truly be smoothed, shared data entry is also valuable. “A lot of people use a shared care record to view data, and that’s an excellent starting point. We’re finding that more and more people can benefit from actually inputting to that shared care record – different teams and clinicians from different care settings can contribute to a pathway, for example, that’s sitting on top of that shared care record.”

The value of a shared digital system which enables both viewing and entry of data was echoed by Richard Cullen, the chair of Rotherham Clinical Commissioning Group. “A big help has been that all the community team and almost all apart from three practices and the mental health team are all on the same system,” he said.

“That is bliss, managing patients when you can see everything about the patient. The big sticking point is actually not digital – it’s who takes responsibility for the patient and when. That can be helped by digital but is the big sticking point for primary care on discharge [of a patient from hospital].”

It brought the debate to a theme that would prove central: digital will only be able to help improve pathways if strong relationships between different parts of the system are already in place.

“The elemental piece in all of this, to help with hospital demand, is a relationship with primary care,” argued Sultan Mahmud, director of innovation, integration and research, The Royal Wolverhampton Trust. “And for us to build that trust, it takes a lot of time and engagement.”

It was work, he said, that had made it possible for the local area to create a data dashboard which is accessible to any clinician and which draws on information gathered from across care settings.

For Dr Stephen Dobson, creating a technical “architecture” in which information flows easily will be central to smoothing pathways and reducing unnecessarily long lengths of stay in hospital.

“[You need to create] that convergence architecture across a wide group of organisations so you’re all on a path where you’re trying to reduce the complexity, reduce the number of systems, and you’re creating that common architecture that you can all understand,” suggested Mr Dobson, chief information officer at Lancashire Teaching Hospitals Foundation Trust and Central Lancashire CCG.

“In Lancashire we’re moving towards a common EPR [electronic patient record]. That makes it a lot easier to communicate and share data, information, and prevent those admissions where they’re not necessary and reduce length of stay.”

As Debbie Pope, country manager UK and Ireland and Capsule Technologies, put it: “We all want digital pathways”.

She continued: “Where I’ve seen significant progress within hospitals is where they do have [digital] systems that are working across the whole hospital. Obviously, there are barriers to be able to succeed in that.

“I think for a clinician to actually have accurate data, to have actionable insights, is what’s fundamental. And it can only be accurate if it’s digital.”