Case study: Information management

Info Cabinet: a search tool for monitoring quality of hospital care

The Healthcare Commission, which joined with other regulators to form the Care Quality Commission (CQC) from 1 April 2009, developed with consultancy and technology company Concentra an innovative enterprise searching and collaboration tool to provide information for a programme of inspections of hospitals across England.

The programme assesses how well prepared hospitals are to tackle healthcare-associated infections (HCAI) and also how safe and clean wards and patient areas within the hospital are. New regulation to ensure hospital patients and staff are protected against HCAIs came into force on 1 April 2009. This requires hospital trusts to have effective operations to assess risks of infection and prevent, detect, treat and control infection.

The Healthcare Commission was, until 31 March 2009, the health watchdog for England, established to carry out a variety of statutory functions including the assessment of how well hospitals deliver their responsibilities of providing good quality care for their patients.

As part of this, the Commission relied on accessing and using high volumes of information and developed the concept of ‘information-led regulation’. As part of this function, the Secretary of State asked the Commission to conduct a programme of inspections of hospitals in England. This was following a number of high profile cases where patients contracted HCAIs such as methicillin-resistant Staphylococcus aureus (MRSA) and subsequently died.

To aid in the delivery of this programme, the Commission wanted to bring together a range of information sources such that could be combined to give a rich picture of the hospital being inspected. This meant finding a way of combining contextual information with structured data sources to produce information packs for staff conducting the inspections. Sources to be included in this process were to be taken from Government websites, newspapers and internal documents.

The drive to develop and use an enterprise searching and collaboration tool was therefore based on providing an information source to inspectors that would improve how they conducted their inspections.

The Info Cabinet

The enterprise searching application was commissioned by the Healthcare Commission as part of its three-year informatics strategy with the specific aim of being able to use more and better information to underpin the model of information-led regulation. The first use of the application was the HCAI inspection programme. This was chosen because it required a quick turn around in the provision of information and also required interrogation of multiple information sources.

The resulting tool, based on the Microsoft SharePoint portal and information aggregation platform and utilising leading-edge techniques in meaning-based computing, from partner company, Concept Searching, is branded the ‘Info Cabinet’. The advantages of using SharePoint as a basis for the Info Cabinet means it is scalable, flexible, and leverages existing skills and knowledge.

Concept Searching spots links between different but related instances of key terms, expressions and themes in unstructured data and also integrates with SharePoint and achieves what other proprietary meaning-based enterprise search systems do but at a fraction of the cost.

A first version of the Info Cabinet was used by a core team of analysts to support the programme of HCAI inspections. A wider group of staff in Operations and other departments also have access to the application. Remote access for home workers and staff in regional offices is also available.

In this project phase the Info Cabinet is acting as a sophisticated information aggregator and proving itself a powerful tool for strong information management and for highlighting trends and significant events.

While to users the Info Cabinet looks very similar to popular public search engines like Yahoo! or Google, under the bonnet it has a set of very powerful additional indexing, intelligent search and retrieval and classificatory features that mean it can greatly simplify the aggregation of a very diverse range of relevant information sources and repositories, and thus increase the value and accuracy of the results.

Such sources are primarily derived from the organisations it regulates, along with information from other key data sources such as NHS hospital websites, online medical directories such as LexisNexis, the BBC, Government sites such as Info4local.gov.uk and Directgov, as well as many others.

Info Cabinet in action

The comprehensive nature and timeliness of Info Cabinet as a tool for HCAI project work was praised by users. The vast majority of participants polled in a follow-up evaluation noting the quality of the information pulled back by Information Cabinet was never less than ‘good’ when compared to information delivered by other search engines when used for related topics.

One user commented, “This is an enormously useful tool for anyone trying quickly to make sense of myriad sources of information and draw reasoned conclusions,” while another praised it for the fact that “the application pushes information towards the user in an intelligent way”.

The clear majority (85%) of users characterised the list of sites/ information generated by Info Cabinet as a “near perfect fit”, which in practise meant greatly reduced time spent by them searching for relevant information.

The Info Cabinet users also praised its speed. On average it took just 6.5 minutes to reach the target information they were seeking, a time that includes both learning time by the system and analysis of results. Previously, it would have taken the team of analysts collating and compiling the information for inspections much longer.

Where will Information Cabinet go next?

It is expected that the Info Cabinet will be useful for the new body as a whole, acting potentially as a common desktop tool for the regulator to compile information, help produce reports and act as a 'one-stop shop' for CQC staff information needs.

This will be undertaken through the addition of topic pages and additional work streams to the application. In addition, the SharePoint-based solution is expected to further expand collaborative ways of working at the new body.

Rupert Fawcett, project manager for the Info Cabinet is convinced there is huge scope for it and its possible successor systems right across the health and social care regulatory sector in the UK: “We hope the right knowledge will facilitate the information risk-based approach we champion. There is so much that can be done with a tool like this.”

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