To complement our new report, Delivering the benefits of digital health care, we’re running a blog series exploring how digital information technologies can help to transform health services. The series is a mix of interviews and thought pieces from a range of perspectives including frontline staff, digital practitioners, researchers and others.
Paul Henderson, Director of Health Data and Analytics at KPMG, outlines why investing in health care data should be a priority for all NHS boards. KPMG supported the development of our report.
Do you always have all the information you need to do your job to the best of your ability?
Over the years, I have posed this provocative question to countless NHS board members. No matter who I ask – Directors of Performance, Directors of Finance, Directors of IT or even Chief Executives – the answer is generally the same: no.
When I receive this negative reply, I follow up with another question: what is it you feel you should know but don’t know currently? Invariably, five or 10 issues are identified, the resolution of which would improve clinical and operational effectiveness. Yet once the conversation moves onto making the investment which could provide the information needed, it sometimes stalls.
Health care data as the basis of transformation
New technology and increasing digitisation is transforming health care, as The Nuffield Trust’s excellent new report highlights. As it also identifies, however, there are challenges for boards when it comes to making strategic decisions about investment in information and digital technology. I would argue these challenges are often behind the negative response to my question about information.
In an era of extreme financial challenge for health care, there is an understandable desire to have a clear business case for any investment that shows precisely which returns will accrue and when. Unfortunately, making such a case for data or technology in health care is virtually impossible, since neither has an inherent value. They only gain worth when used as the foundation for a deeper transformation.
This is a point strongly made by the report’s authors, who argue that health care organisations need a transformation programme supported by technology, not the other way around. They suggest this is “the fundamental lesson that underpins everything else”.
Some brave people out there are sticking their heads above the parapet on this issue. They realise it is impossible to make a business case for data in its own right, and appreciate investment in getting the numbers is simply part of the cost of doing business – part of retaining competitiveness, developing effectiveness and encouraging quality of care.
Why all boards should care about data
This bravery is typically linked to frustration at constantly looking in the rear view mirror, often tied to a clear push for change: a poor report from the Care Quality Commission, a financial deficit, or some other troubling measure of performance. Yet I would argue data and analytics must be a priority for every NHS board. That does not just mean having monthly performance reports on the metrics, but using data to inform changes to service delivery and to alter the way in which people are using those services – so, for example, managing demand and improving clinical effectiveness.
It is about knowing clinical outcomes, tying them back to a patient’s vital signs data, and seeing if an avoidable complication occurred – and then changing practice to help clinicians identify and respond more quickly to the complication. It is enabling patients with hypertension to take blood pressure readings at home, which they then digitally share with relevant health care professionals, receiving relevant and timely health advice in exchange. It is analysing unhelpful variations in clinical practice, and then eliminating them.
From spending habits to health care outcomes
It is also collecting and harnessing very different types of data. For instance, I have only once stayed overnight in a hospital. The service therefore has little to no information on my likely future need for care. Yet if a fast food chain were planning to open a takeaway in my area, you can guarantee its managers would know a great deal about my likely future consumption of burgers and fries. To make such a judgement, they are likely to have examined my spending behaviour, social behaviour, even what my interests are.
The chances are such data also contains hints as to my likely future use of health services (certainly my propensity to consume fast food would). In my own firm, our decision science unit harvests enormous amounts of this sort of information – we could take curated retail data and match it to health and social care activity data, for instance.
I believe our future understanding of population health lies in this sort of data. Yet few, if any, boards within health care organisations are currently in a position to look at such information, or even at more basic data which could help change practice.
Reason for optimism
Do not mistake me for a pessimist on this agenda, however. I am hugely encouraged by the Five Year Forward View’s focus on place-based commissioning, which I think has the potential to fundamentally change how we look at population data in health care. I am also hopeful the sustainability and transformation programme will give organisations funds and time with which to get the right data and make the right changes based on it. And I know that everyone who works in health and social care does so with a genuine desire to help people.
What we need now is an understanding that data, information and technology are a crucial part of allowing us to offer that help. We need more people who, once they’ve told me they don’t have all the information they need to do their job, are willing to invest to change that fact.
The views presented in this blog are those of the authors and do not necessarily represent the views of the Nuffield Trust or our partners.
All product and company names mentioned throughout this blog are the trademarks, service marks or trading names of their respective owners, and do not represent endorsements.
Henderson P (2016) ‘Mind the health care data gap’. Nuffield Trust comment, 23 February 2016. https://www.nuffieldtrust.org.uk/news-item/mind-the-health-care-data-gap