In England, the 152 primary care trusts (PCTs) that manage healthcare services provided by GPs, dentists, opticians and pharmacists get 80% of the National Health Service’s budget. But until recently, many didn’t have business intelligence (BI) tools that gave them a firm grip on their spend, potentially wasting millions of pounds of taxpayers’ money.
Only a couple of years ago, the BI systems at PCTs were often basic setups based on Microsoft Office, with staff pasting data into Excel and emailing information to one another. Complicating things, many PCTs were merged in 2006 to align them with local-authority social services systems. And then last year, just as they were completing the resulting systems and data integration work, PCTs were split into separate healthcare services commissioning and provider units, creating fresh data integration and analysis challenges.
But an enterprise licensing agreement signed by the NHS and Microsoft in May 2007 introduced more broadly functional tools such as SharePoint for use by PCTs, and numerous organisations have installed or are developing new BI systems via that deal.
Among them is NHS North Staffordshire, a shared agency supporting two PCTs and mental health trusts. Simon Clements, associate director for health intelligence at NHS North Staffs, said the organisation previously took a rudimentary approach to BI.
“We had one data repository and we dumped all the data in there, and we just took out the bits we needed for the specific task at the time,” he said. “We needed to create data warehouses for each of our [business units], and then we needed to provide data in a more user-friendly way. We had used Excel cubes, and we were data-rich and information-poor.”
Healthcare business intelligence goal: improved business processes
NHS North Staffs is now implementing a Microsoft-based BI system with expanded data analysis capabilities that Clements hopes will help drive improved business processes. “I need to change my analysts from bean counters to [focus on] analysis for improvement, so they can actually look at the data themselves and start making recommendations,” he said.
That did happen during a proof-of-concept project for the North Staffs commissioning arm, which revolved around A&E data from the University Hospital of North Staffordshire. “When we started looking at the information,” Clements said, “questions were coming up immediately.”
For example, the data showed that a nursing home located about 10 miles from the hospital was consistently sending residents to the A&E department for treatment, whereas a nursing home just a mile away hardly sent anyone there. Armed with that information, workers at the PCT were able to approach the first nursing home and offer to do an analysis aimed at stopping people going to the hospital unnecessarily.
A key reason for merging PCTs was to enable them to share information with social services organisations, hopefully leading to the development of predictive models for preventive medicine. In the future, Clements wants to add demographic data and other “social marketing-type information” from local authorities to the NHS North Staffs BI system. Doing so would let his staff “look at where there is the biggest need for a service,” he said. “That would be really brilliant. [But] it is probably a bit further along the line.”
The BI deployment hasn’t all been plain sailing. Clements said officials wanted to start with relatively small proof-of-concept projects at individual units and then roll out the system all at once in order “to move everybody forward at the same time”. But, he added, the proof-of-concept work progressed “at different speeds, so we have four projects instead of one big one.”
NHS Islington in London uses a SQL Server-based data warehouse, built with help from Reading-based IT consultancy Insource Ltd., to take daily-activity data extracts from the main London clinical records system and publish them within 24 hours to Web-based reporting pages for each of its service managers. The managers can then use reporting tools to view metrics such as working time data, how long people are waiting for care and patient outcomes, said Ian Tritschler, head of business development at the PCT.
Healthcare BI system helps with staffing, data quality issues
The data, presented as gauges and dials in dashboard style, also lets NHS Islington officials spot treatment vacancies in clinics where more staff need to be deployed. “For example, our podiatry service operates from about six different sites, and now we can very quickly see where we have a spare clinic slot and book [a doctor] in electronically,” Tritschler said.
In addition, the BI system has uncovered “a whole load of data-quality issues” that previously went undetected, according to Tritschler. “It is not rocket science,” he said of the system. ”It is probably what we should have, but not all PCTs seem to have actually cracked it.”
NHS Islington is also ahead of the curve in developing patient-level costing capabilities based on the actual amount of time that clinicians spend with patients. The new costing tools were rolled out in January across 20 of the PCT’s 32 service areas.
Since the Care Quality Commission was set up last year to regulate health and social care in England, there now is a huge agenda at PCTs around the patient experience, including surveys to get patients’ views on the quality of healthcare services. NHS Islington has already addressed this in its BI system as well, Tritschler said, noting that information from user survey forms are fed into the data warehouse so that service managers can see “what is essentially a user satisfaction score”.
David Arrowsmith, head of information at NHS Derbyshire County, is at an earlier stage with his healthcare business intelligence development. “We have been slower off the mark than perhaps we wanted to be,” he said.
Light bulb comes on about healthcare BI’s potential
Initially, PCT officials resisted using off-the-shelf reporting tools. Then, Arrowsmith said, they became aware of Microsoft’s PerformancePoint Server and SharePoint Server software, and “the light bulb came on” about how those products could be used to set up a reporting system.
Arrowsmith said the PCT recently finished a proof-of-concept project in which it converted a board of directors report from a PDF file to a SharePoint and PerformancePoint document in order to make the report available electronically, with added functionality such as drill-through capabilities built in.
NHS Derbyshire went with Microsoft business partner 21C as its service provider on the BI implementation, and through the vendor relationship it has started to share its experiences with other PCTs, forming a network with half a dozen other organisations.
“We are not good at it in the NHS – sharing things like this,” Arrowsmith said. “We have had to solve the problems ourselves. I think with PCTs you have your noses to the grindstone, and sometimes you are not very good at looking up and scanning the horizon.”
Even with the recent upgrades, PCTs still have their work cut out for them on BI, as the flow of government initiatives aimed at improving healthcare services and controlling costs continues. For example, the NHS’s World Class Commissioning and Practice-Based Commissioning programmes both call for improved BI capabilities to help drive improvements in how services are commissioned.
Tracey Caldwell is a freelance writer based in the UK.