Healthcare management, business intelligence

The NHS and business intelligence: towards true world class commissioning

Business intelligence (BI) is a hugely useful way of working with data as a way to effectively ramp up business performance, and is a technique that's been used by many successful public and private organisations. But it remains all too often an unrealised dream for the NHS.

Using web-based business intelligence, however, the NHS is benefitting too and addressing the Government’s vision for World Class Commissioning, explains cancer expert and seasoned commentator on health and management issues, Professor Roger James.
July 2009

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 around the best way to deal with the huge legacy of data and information the institution has built up, such as the standoff between those with clinical data and those with managerial data.

There are also far from inconsiderable issues around the vast collection of IT systems and arrangements the NHS deals with, the National Programme for IT (NPfIT) notwithstanding, 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).

Finally, many NHS systems are using green-screen, client–server technology, which is not connected to the Internet, and are quintessential 'islands of information'.

Any suggestion that there's a quick fix solution available however should be resisted. What’s more, the NHS is wary of any sort of ‘top-down’ IT approach that promises any 'magic' solution. Does this mean that data is always going to remain locked away in the different NHS systems without any potential for further use or analysis?

One possible use for that data would be in a modern business intelligence (BI) system that could start unlocking the hidden value in that information and start providing clinicians, administrators and commissioners much more powerful ways of seeing the bigger picture in their organisations or networks.

A system that 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. Is this realistic? The good news is that by adding a web layer to NHS data, impressive results can soon be seen.

For instance, The Cancer Commissioning Toolkit (CCT) is just such a web-based BI tool that's providing an online, national view of responses and actions on one major disease area, 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 an NHS term for planning and purchasing healthcare.)

Key features of CCT

Since being released in autumn 2008, CCT has experienced rapid take up across the NHS, with over 200 users accounts being added each month. Its key features are:

  • password-protected accessibility by NHS commissioners and providers and other non-NHS stakeholders;
  • aggregation and centralisation of key commissioning information, providing easy access to standard (and regularly updated) data removing the need to navigate multiple and disparate systems;
  • presentation of cancer datasets in an intuitive graphical manner with detailed guidance at chart level, assisting in the interpretation of complex variables and their wider implication;
  • benchmarking of variables between comparable clusters, enabling performance comparisons and improvements;
  • displays of information at different levels of detail, for different health economies, enabling high-level assessments as well as in-depth analysis of key cancer topics, for example from a dashboard of key cancer variables viewable at PCT/Network level to analysis of Length of Stay (LOS) for specific procedures;
  • provision of a common platform for analysis and planning, enabling and encouraging dialogue between commissioners, cancer networks and providers of cancer services.
A ‘one stop’ library of cancer information and data, it has been hailed as "a major step forward" by UK Cancer Tsar Mike Richards. CCT is an online, national approach containing many features of truly 'best practice' BI. It 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.

It 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 Office tools such as Word and Excel. As stake-holders already own and understand these tools, they’ve already got the skills to start using them, which brings integration and deployment overheads radically down. As a result, processes and decisions are much more transparent to stake-holders from different sectors.

One CCT director has noted, for instance, that “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.”

Richard Hancox, Arden Cancer Network Director said,“I am sure this Cancer Commissioning Toolkit, which is a tribute to the vision of the National Cancer Action Team, will set the standard for the development of comprehensive, accessible information on health services for a wide range of disease areas in future.”

Professor Mike Richards, National Cancer Director, said, “The Cancer Reform Strategy identified better information and stronger commissioning as two of the key drivers to achieve our goal that cancer services in this country should be amongst the best in the world. The launch of this Cancer Commissioning Toolkit represents a major step forward in relation to both of these drivers for quality improvement.”

The ability for a cancer network or NHS trust to benchmark performance against national or similar regional characteristics will also be extremely important as a driver for improved quality across the service.

Another valuable BI idea featured in this system, but easily incorporated in the other systems, is the ‘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 stakeholders 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.

How can we do this? 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.

Case study of inefficient spend

As an example of the way the Cancer Commissioning Toolkit (CCT) project will deliver a radical change in the delivery and quality of a service, here is just one instance of benefits outlined by the National Cancer Action Team (and used as part of the ten regional CCT roll-out events that have just taken place).

The CCT is able to demonstrate possible causes for higher than average expenditure on in-patient care, hospital cancer emergency admissions, number of deaths in hospital rather than at home and a higher occurrence of cancer emergency bed days above trim point (such outputs give a flavour of the type of information available in the Toolkit).

A PCT sees that more analysis is required that could lead to such actions as the cancer network team identifying and addressing the reasons for the high number of cancer emergency bed days above trim point as well as increased focus on developing community-based support for end of life care. Such work could then be incorporated into an existing PCT project on early discharge with social services.

In contrast, finally, 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.

Professor Roger James
The author is currently a part-time Consultant in Oncology in the NHS. He has over ten years experience in senior NHS management at both Clinical and Medical Director level. He has an NHS Platinum (A+) award in recognition of services to the NHS services. He was National Modernisation Agency National Service Lead for Chemotherapy and Governance lead, a member of the National Cancer Network Clinical Director's Group member, and a member of the National Cancer Action Team Clinical Advisory Committee. He was a member of the Steering Committee for the National POI Capacity/Demand Project. He chaired a national Joint Collegiate working party on the commissioning of cancer facilities. He has a lifetime’s experience of publishing research and teaching. He is national principal investigator of the largest world-wide trials of chemo-radiotherapy for Anal Cancer and Intra-Hepatic Chemotherapy. In 2002-3 he edited Managed Care Networks and was co-author of Governance and Revalidation.

For more information on the CCT system please see:
www.concentra.co.uk/casestudy.aspx?itemid=86&title=cct%20cancer%20commissioning%20toolkit%20case%20study

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