I’ve worked in health informatics for longer than I wish to say, and have worked for various organisations. Yet I still find the same issues; no central data repository and very little business intelligence (in the true meaning of the term!)
I’ve just started working at my current trust, and it’s not been a surprise that it follows this pattern. Don’t get me wrong; there are NHS organisations that have immense data repositories and enhanced business intelligence – so what is it that holds some other organisations back?
When leaving the supermarket, we get vouchers that give us offers on the things that we normally buy. Stores send us promotional offers based on our store card shopping habits. Phone companies tell us our usage and offer us better deals…
These things always get me thinking… why do we, the NHS not have the personalised intelligence that other organisations have developed and are using with such success?
What can you do without a repository?
Organisations can get by without sophisticated data repositories and still produce analysis for both decision making and central reporting. However, it does make it more difficult and time consuming. It can also add to the issues around data quality and consistency.
I am biased when it comes to data repositories and can’t justify not having one. There are different definitions of a ‘data warehouse’, for me it’s a single data store holding normalised data from multiple systems/sources. This data repository then provides us with a ‘single view of the truth’.
Data repositories can be very expensive; but they don’t have to be. You can create one using your existing resources. In some trusts I’ve been fortunate to have highly skilled technical staff who, for whatever reason, have just not had the vision or time to build this kind of resource previously; although in other trusts the skillset hadn’t existed.
With NHS organisations having such a multitude of systems – from the central patient administration system to departmental and bespoke systems – I have to wonder what organisations without data warehouses have been doing.
Have they just been ‘getting by’? Does using multiple sources really deliver sufficient business intelligence? Does it ever provide that ‘single version of the truth’?
Analysis – aim for accurate rather than creative
If the NHS is notorious for having numerous systems, then there’s the added complexity of how the data is extracted and analysed, which leads to the longstanding issue of which answer is the right one?
Generally, you can get data to give you whichever answer you’re looking for, using various creative analyses. However, as informaticians, we should be ensuring our analysis is accurate rather than creative.
The ‘single version of the truth’ reduces the inconsistencies. Add on a business intelligence solution and we create the ability for a much wider customer base to interpret complex data very quickly and easily. Of course, we need this to be in ‘real time’ to give operational managers the information they need to act ‘now’.
Creating data repositories without a clear strategic vision and understanding the needs of the organisation can be a waste of resource.
We as informatics professionals need to work with our customers to identify what information will be useful and provide the intelligence to inform their decisions.
No matter how sophisticated our business intelligence tools are, without operational engagement and understanding, real business intelligence will not materialise.This change needs to be cultural.
Stopping rubbish in and rubbish out
With the current financial climate, and the NHS being driven into doing more for less, more and more organisations are looking at how business intelligence can provide answers to efficiencies and improvements in terms of patient care, quality and, of course, finance.
For business intelligence to really provide those answers the persistent issues of data quality and integrity need to be addressed.
Our data integrity is dependent on the end user; as the saying goes: ‘rubbish in, rubbish out’. However, we shouldn’t hold back with our reporting because the “data is rubbish”; data quality is the responsibility of everyone entering data. It can actually be a persuasive way to improve data quality and encourage cultural change.
In one of my previous trusts, the clinicians felt they had no responsibility for data and initially completely disregarded the reporting provided to them.
The medical director, who was the most influential person in this situation, was a huge supporter of informatics and understood the power of information. With his support, the cultural change with some of the clinicians was extensive.
The improvements to data quality materialised and business intelligence enabled improvements in quality, while providing opportunities for efficiencies.
Having experienced the impacts of good business intelligence combined with cultural change, I’m certainly looking forward to the challenges ahead!
Aasiya Moreea
Aasiya Moreea is a health informatician; currently assistant director of clinical information and business intelligence at Bedford NHS Trust.
Aasiya has expertise across all Informatics areas, with a special interest in business analytics and performance frameworks, particularly focusing on performance, quality, and patient safety metrics and also service line reporting.
Aasiya has led health informatics within a number of NHS trusts over the past ten years (both foundation trust and non-foundation trust). She is a published writer and also works with CIMA to provide training courses on various areas within finance and informatics.