Everyday opportunities to improve care?
By: Dr Tom Foley (left) and Dr Neil Lawrence (right)
Many clinicians will have spent time selecting the same series of buttons and perusing the same drop-down menus for a long list of patients today. They could indeed be forgiven for cursing the Electronic Health Record which they are mandated to complete, and for wondering how much time is wasted by collecting all this information. Some might even think that things would be better if we went back to pen and paper. We’ve both been there.
But stop for a moment and think about what we could do with all that data, from every patient and every doctor, in every hospital and General Practice across the land. This begins by sharing it with other clinicians for direct patient care, but that’s only the start.
We could search the data for information that is predictive of high risk or high-cost events for our patients or for entire health and care systems. We could even create predictive models that identify patients or situations who are most likely to respond to particular interventions. For example, which patients are at most risk of developing sepsis? Which patients are most likely to respond to particular antibiotics?
We could use the data to compare the performance of different teams, different hospitals or even different countries. When we identify particularly good performers, we could learn lessons and share them with the rest of the system, fostering a truly national sense of continuous improvement.
We could combine data from across large areas to understand how diseases differ or spread from place to place. We could use the same approach to identify adverse effects from medications or medical devices much more quickly than is currently possible.
We could even change the way that clinical research is conducted by using the data to identify potential trial participants or even overcome the need for Randomised Controlled Trials, in some cases. If you have taken the time to enter your patient’s demographic details, symptoms, diagnoses, treatments and outcomes, then why couldn’t we combine that with all the other patients who share the same diagnosis and compare which treatments work best.
All these things are already happening in the NHS, to a greater or lesser degree. As these uses of data become ubiquitous, it will transform the way we practice medicine and the way that we lead the system. Artificial Intelligence won’t be putting clinicians out of work any time soon, but we will need to adapt. We will need to take more care in recording data, we will need to make sense of more data from within the health system and from our patients’ consumer devices. We will learn to work with increasingly intelligent systems for supporting our decision making.
Collecting data places a burden on the system, but we can use data to effect real change to patients’ care. It isn’t easy to make this case to a busy clinician in the middle of winter pressures, so we need to demonstrate real benefits by making their lives easier. Both patients and clinicians can be suspicious of sharing their data to benefit strangers, but equally, they can be motivated by the same altruistic drive that leads them to donate blood.
It isn’t just clinicians who will have to change. Researchers will need to develop skills in retrospective observational studies and innovative trial design. Policy makers will need to balance the increasing availability of data with the unintended consequences of performance management in a complex system. Commissioners will have greater information on and greater responsibility for their populations. Patients too will have more information to make decisions about their care and to understand the impact of lifestyle choices on their outcomes, but they will have to cope with the anxiety and uncertainty that might bring.
The UK has some of the most advanced data assets in the world. Clinical leaders can be empowered by data, but only if they understand its uses and limitations. Next time you click submit, stop to think how that data might be used to improve care. You might be surprised.
Dr Tom Foley, Senior Clinical Lead for Data, NHS Digital
Dr Neil Lawrence, National Medical Director’s Clinical Fellow