In an elderly care ward at North Bristol NHS Trust, a GP is paying his patient a visit. No, this is not community hospital but an acute trust and no, the GP does not have admitting rights.
What he does have is a GP dashboard developed by the trust that alerted him when his patient was admitted to hospital, and alerted him again when she was expected to go home. He is visiting her to help the discharge to go smoothly.
A BI project
At the moment, he is also involved in a pilot project that not only involves the dashboard but a complex piece of work around how consultants and GPs liaise.
But the project would not be possible without the widget, which hinges on the trust’s business intelligence system. Two years in the making so far, this in-house initiative was a joint winner for Excellence in Healthcare Information Management at the E-Health Insider Awards 2009 in association with BT.
Martin Bell, director of IM&T, explains the origins of the BI initiative. “Most NHS trusts now have pretty good financial information,” he says. “Many have good activity data too. Very few have brought these together.
“We wanted to create something where managers of all descriptions, including clinical, could access the information themselves and run their own reports.” The trust also wanted to make data available externally, for example to primary care trusts, its strategic health authority and GPs.
The trust hoped that by doing this it would free up some of the time that analysts spent responding to requests for routine reports and allow them to do more complex work.
Helen Ainsbury, deputy director of IM&T, took the lead. Using a dedicated project team that included two new recruits, and working with standard Microsoft tools, she delivered a data warehouse pulling together information from over 30 existing systems and allowing users to view information from across the trust.
“On top of that we have put in a lot of clever logic to make the information accessible in a wide variety of ways,” she adds. That includes a web front end, automatic email systems, reports to which users can subscribe and dashboards. “People can choose how they access the information they need for their job.”
Engage and then engage some more
A crucial part of the project’s success has been the clinical engagement, with the phrase “engagement, engagement, engagement” becoming something of a mantra.
The approach has been to develop a product and take it out to the clinicians to see what they think. “It’s no good asking people what they want unless you show them first what is possible,” says Ainsbury. “It’s only then that you can hope to get their input, as you continue to develop and refine.
“So a major part of what we do is show people what we have developed but at a very, very early stage. That might be in meetings, one-to-one or by specialty or whole directorate. We do things with ward administrators as well as consultants.”
More than a BI project
These days, clinical and general managers at North Bristol NHS Trust are busy running their own analyses of theatre utilisation and throughput, patient level costing and service line reporting.
Ainsbury says: “They can see whether other services or another clinician or different specialty or HRG [healthcare resource group] is profitable and what are the drivers for them being profitable. While a lot of these things might seem as though they are cost focused, the drivers are actually around performance issues.”
The trust is already sharing information externally. For example, it is working closely with the local PCT, sharing data on performance management and Commissioning for Quality and Innovation (CQUIN). Ainsbury says: “There is more transparency around the data and it is just much easier to communicate with them now than it was.”
Perhaps the final thing to say is that nobody at the trust regards this as a one-off project. It is a continuous work in progress, both on the technical front and in the engagement with clinical and managerial staff across the entire health economy that underpins it.
“This is very much a live journey,” says Bell. “We are never satisfied and want to go further.” Ainsbury agrees. “I think the most exciting stuff is still to come,” she says. “The need for it is just about to kick off.”
In the immediate future, the priority is on building in the patient level costing and quality measures. Ainsbury says: “We are doing a lot on quality right now, building in meaningful outcomes about our safety and at the same time identifying areas where we can make efficiency savings, for example in non-pay expenditure or procurement expenditure.”
In the longer term, Bell wants to see the system able to triangulate cost and quality with workforce data: for example looking at how skill mix changes affect cost and quality or whether closing a ward would actually drive down costs. Finally, he would like to build in clinical audit as another data point.
“If you can bring all this information into one place, then you have an enormously powerful tool for a variety of functions,” he says. “It really then becomes a matter of asking the right question.”
The missing link
Winning the award is a recognition of just how far the trust has come and Bell pays tribute to Ainsbury. “She has been fantastic, a real whirlwind,” he says.
“Her role has very much been batting between business needs and how you implement that in a technical information reporting sense. That has been an absolutely key link and one that many NHS information departments seem to miss.”