Stephen Armstrong investigates the application of information technology in healthcare against the need for NHS cost savings
Discussing the future of healthcare often means looking at the past. You could argue, for instance, that modern healthcare began with the Victorian version of big data.
Back in 1854, physician John Snow started crunching data on London’s worst cholera outbreak, which killed 616 people. Through interviews and mapping, he showed which water pump was to blame and the resulting statistics showed that it was not a miasma, nor noxious air, that caused the outbreak, as contemporary medical thinking had it. Snow’s work lead to germ theory and an understanding of the importance of a clean water supply. Even as early as the 19th century, the message was clear – the right sort of data can save lives.
Accessing the information was straightforward for John Snow, but today it’s more complicated. Over the past 15 years, the NHS has been adding new IT systems in a relatively haphazard fashion. Some hospitals can have up to 30 different systems running in parallel. There are national databases – like the National Patient Safety Agency or the National Immunoglobulin Database – but they don’t talk to each other.
The technology exists to allow simple access to medical records, patients to book appointments online with GPs, researchers to access test results in the cloud or managing a hospital’s information system, but questions about ease of implementation, IT staffing and the safety of patient data remain.
We now have the opportunity to use information to achieve new goals in the healthcare system
“European healthcare systems are in need of reform,” argues John Crawford, IBM’s healthcare industry leader. “Efficiency, quality and access are the three key areas of reform, and this process is underway in most countries. Adoption of eHealth services with robust and secure platforms will help new health services to be delivered, but will succeed only as part of transformational change and service redesign programmes.
“The accelerating adoption of eHealth is leading to increasing volumes of digital health information, which can be processed and analysed to increase efficiency, raise quality and improve access. We now have the opportunity to use information to achieve new goals in the healthcare system.”
Of course, there are perils. In April, the Information Commissioner’s Office (ICO) fined the Aneurin Bevan Health Board £70,000 following a serious breach of the Data Protection Act after a sensitive report containing patient information was sent to a former patient instead of a consultant’s secretary.
“To a degree the problem is that data has always been in the hands of IT departments rather than in healthcare professionals’ hands,” says David Bolton, director of public sector market development for QlikTech, a healthcare software provider. “The advent of tablet computers, smartphones and wi-fi means doctors and nurses can access data instantly anywhere. With that comes the responsibility of good training and secure systems, but the benefits can be huge.”
Mr Bolton points to Newham University Hospital NHS Trust, serving 240,000 people in East London. Using QlikView software, reports that would take one member of staff an entire working year to produce now take a quarter of that time – with 100 people able to access the report via an online dashboard saving £128,000 a year and improving performance.
But the UK is actually trailing when it comes to implementing this sort of technology. Narayana Hrudayalaya, for instance, is a collaborative or co-operative of health centres in southern India which operate a little like Walmart meets Mother Teresa.
The company runs a micro-insurance programme that enables three million farmers to have coverage for as little as 20 pence a month. High-paying patients, including many from overseas, help support this system. Every day, the collaborative’s surgeons receive a profit-and-loss statement of the previous day that describes their operations and the various levels of reimbursement. The data allows them to add more full payers, if necessary, to balance costs or allows more low-paying farmers if the balance sheet is healthy.
“When you look at financials at the end of the month, you’re doing a post mortem,” says Dr Ashutosh Raghuvanshi, Narayana Hrudayalaya’s chief executive. “When you look at it daily, you can do something.”
Although the NHS doesn’t have the same payment issues, Adrian Simpson, chief innovation officer at SAP UK & Ireland, points out that cost concerns will only increase. “With the NHS under pressure to identify £20 billion of cost savings by 2015, running the organisation as efficiently as possible is vital. The best level of healthcare involves managing data, containing costs, improving resource efficiency and maximising productivity.”
This may take time, of course. It took years to acknowledge John Snow’s work. When he died in 1858, his obituary ignored his research. But the next big cholera outbreak in 1866, however, benefitted from “the light of Snow’s research”. His big data eventually removed the disease from the Western world – but it took time.
Terabytes give data real teeth
Charité University Hospital Berlin is one of the largest clinics in Europe. In 2010, its doctors treated more than half a million patients. The hospital runs clinical trials – with some 500,000 data points – while test results contributed to a 30 per cent rise in the volume of digital data the hospital had to manage. Ironically, the more data there was, the less it was used because there was no quick way to access it.
In 2008, the hospital installed a combination of SAP Healthcare software and in-memory computing, which allows calculations to take place in a computer’s memory rather than on its clunky hard disk.
The new system meant data could be processed in a quarter of the time. In 2010, the hospital introduced additional software that allowed real-time access to patient data, meaning users could see key information immediately, data could be evaluated directly and doctors had instant access to information – and more time for their patients.
Sharing results with partner institutions meant treatment was prescribed more quickly while eliminating redundant treatment. “Today we analyse terabytes of data in a matter of seconds,” says Martin Peuker, Charité’s vice chief information officer. “This is of great advantage to both the executive management as well as to the doctors and patients.”