The Nuffield Trust and the Commission for Health Improvement have both highlighted the need for the NHS to improve its use of information. Stephen Pincock investigates.
When the Nuffield Trust published its latest report on the government’s efforts to improve quality in the NHS, the verdict was painted in broadly upbeat strokes.
But one area of weakness the Nuffield authors spotted was a lack of easily accessible data and analysis on the health system, which left the effect of many initiatives unmeasured.
"I do think that the NHS probably has more performance measurement going on than can be constructively used at present, but there’s still a need to make it more rational, clinically meaningful, and credible," author, Sheila Leatherman said in an interview in The Lancet.
What the Nuffield report says about the health service as a whole is echoed in what the Commission for Health Improvement (CHI) is finding in individual trusts. If CHI’s clinical governance reviews are anything to go by, trusts overall fare badly in using information in a clinical context.
CHI told E-Health Insider that out of roughly 340 trusts assessed so far, 94 scored the lowest rating of I in the "Using Information" component. Not a single trust has been awarded a IV rating in that component, although 26 have managed a score of III.
In fact, use of information is one of three areas CHI has focused special attention on recently . The commission distributed interim results from its "Sharing the learning" project, which is due to formally report early next year.
The results from CHI’s clinical governance reviews show that the use of information is less advanced than other aspects of clinical governance, the interim results baldly state.
Lisa Robinson, a senior analyst at CHI involved in the project said there wasn’t one particular problem that could be identified in the way trusts use information.
"It’s a whole range [of factors]," she told E-Health-Insider. "It is very varied–some trusts have got data quality systems in place and in other trusts it’s a problem. You can’t pick one overall issue."
Use of information feeds into all the other areas of clinical governance, Robinson noted, and the report is based on the fundamental idea that information should allow organisations to better understand outcomes and patients’ experiences of the care they provide. Where trusts are doing badly, it’s this connection between data and patients that seems to cause trouble.
"A clear theme that emerges from CHI’s clinical governance reviews in the less developed trusts is that informatics staff are isolated from the main reason for their employment," the interim results say. "The processing, management and communication of data becomes an end in itself, which is not integrated or related back to providing care for patients."
On a more positive note, in mid-November, the agency started asking trusts that had scored III or IV in different review components to describe how they achieved their good scores. A few have responded with interesting things to say about their information systems.
For example, Dr. David Morrey, head of the clinical information unit and director of IM&T at Velindre Trust, says his group’s approach has been successful because they evolve systems to meet changing organisational requirements.
"We have targeted areas such as patient care and client services and linked the evolving systems to organisational development, which includes developing and training our workforce," he said.
"Our systems benefit audit and clinical governance. Clinical governance is part and parcel of the information systems. Our evolving systems enable us to measure clinical practice and compare it with the best standards published in Europe and the world."
Caroline Parnell, head of communication at Tees and North East Yorkshire NHS Trust says the information management and technology department has a vision: "that every clinician should have easily accessible, up to date information to aid delivery of care."
After a consultation exercise with clinicians, the department devised a strategy to deliver the vision, which included an electronic version of the care programme approach–dubbed eCPA. This was highlighted as a piece of notable practice in the trust’s CHI review.
At the Staffordshire Ambulance Trust, as Dr. Anton van Dellen describes, they use tools based on System Status Management (SSM), a system developed in the United States and adopted in Staffordshire in the early 1990s.
"Being a service industry is similar no matter that the service, whether it be fish and chips or ambulance services. Every service industry is interested in when the customer wants the service, where the customer wants the service, and how many customers want the service," he says.
"SSM provides the underpinning strategy which drives clinical delivery and results in improved patient outcomes."