The Digital opportunities from challenges facing the Health & Care system

Zoe Limbert

In advance of the event The BIG three – essentials of health and care analytics and what does this really mean for changing health behaviour? Dr Jason Broch shares some of his thoughts on health and social care economies:

“There is no need to rehearse the issues facing health and social care economies around the world. Everyone is aware of the increasing demand due to demographic change and soaring costs of care in a system which is primarily activity-based, incentivising a volume industry. This is leading to an explosive growth in costs that is potentially beyond the means of government funding.

Increasingly, around the globe, economies are reaching similar conclusions and moving towards models based in Population Health Management (PHM).

The discipline of PHM is firmly rooted in robust informatics delivery.

At its heart, PHM requires a good understanding of populations. Information needs to support segmentation of the population in to groups of people with similar needs. The role of the care purchaser (commissioner in England) should be to work with populations to understand needs better and to create clear, measurable outcomes. This is supported by outcomes frameworks that already exist within the NHS as well as many joint Health and Wellbeing strategies. Contracts produced should commission for these outcomes, rather than services or specified activity.

Providers will respond to PHM by arranging themselves in a way which allows them to integrate services around the needs of specific people, along pathways of care and across organisational boundaries. The relationships that develop need to be mutually accountable as well as accountable to the commissioner and the public. To deliver outcomes, the pathways will need to define the route from prevention all the way through long-term conditions to end of life. By being jointly accountable within a financial envelope and by being freed up through outcomes rather than detailed specifications, providers will find a way to work with people to support them more, so that they are better able to care for themselves and access care services less. This will shift resource to be more proactive in the care pathway and enable investment in tackling wider determinants of health.

Examples could include some traditional hospital expertise becoming part of extended out of hospital primary care offerings. Partnerships with third sector organisations could support issues like poor housing or debt, releasing resources that could be increasingly invested in prevention initiatives across the whole pathway.

Both commissioning and provision needs to push for integration of traditionally artificially separated Health and Social aspects of care.

This new paradigm brings with it challenges for those that lead and develop IT. To significantly change the delivery model of clinical care will require strong clinical leadership that can not only express the business requirements for technology, challenge peers about how digital capabilities could be used to deliver services more effectively, but can lead clinical colleagues in the adoption of new ways of working including the use of new technology.

There needs to be a shift away from traditional silos of information. The first big challenge is bringing information together. Notwithstanding the regulatory issues, information is captured in multiple

propriety systems, using different standards and with varying degrees of interoperability. Despite this, we need to drive Information Integration. This needs to support direct care with the development of integrated digital care records (such as the Leeds care Record) as a minimum.

The next step is to apply new digital tools supporting delivery of new models of care that use this integrated data. Examples may include integrated devices that support near-patient testing, person held records (including the ability for people to control the sharing of their information) and remote consultation between people and professional or between professionals themselves. A major catalyst for change will be decision support tools – either for people to use or to support care-providers in a way that reduces unwarranted variation in care and facilitates the use of a new skill-mix at a time when there is a deficiency in the number of doctors and nurses available.

There is a growing need to develop an evidence base that supports the use of new technology to support sustainable behavioural change as a function, which can be delivered through new virtual mechanisms as well as face to face.

The final challenge is using integrated information for more robust Business Intelligence. Health and Social care economies need to be able to understand and segment their populations, be clear about delivery of outcomes and get better at understanding true cost. This function needs to support a more robust understanding of risk, both clinical and financial in supporting providers to work in a more accountable way. This will require a good understanding of flow through the system and better use of capacity and demand management across whole pathways. Big transformations, as new models of care are implemented, will need robust measurement to ensure they can be developed in an agile way and the impact is understood, as innovations are scaled. Continuous quality improvement needs to be supported by robust, undisputed data and problem-solving analytics needs to be available.

These requirements are the exciting, emerging new opportunity for the digital sector, as they cannot all be developed in-house. Despite some of the barriers of procurement, Health and Social care economies will find ways to work in partnership with the digital sector and interested citizens to better define the requirements and co-produce the solutions that will ensure effectiveness and sustainability of care systems.”

Dr Jason I Broch, CCIO Health & Care, Leeds, UK

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