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NHS National Services Scotland (NSS) is using data visualisation software to let the country’s health boards compare themselves against each other more easily. It is also extending the use of the software, from Tableau, packaged as an application called Discovery, to doctors and other health professionals in the country.
Michael Muirhead, head of business development at the information services division of NSS, says Tableau was selected, developed and deployed as a product “co-created with our users”. And while the division has been supplying the 15 territorial health boards of NHS Scotland with information, and receiving information from them, Muirhead says it was “in need of a refresh to revitalise the user experience, which had historically been mainly for the eyes of management, not the wider clinical team”.
The information services division supports the analysis of the data that flows abundantly around the NHS in Scotland, which is typically responsible for about 1.6 million hospital admissions, 6.3 million outpatient attendances and 100 million community prescriptions every year. Its job is to provide health information and intelligence, statistical services and advice to the country’s NHS boards and the Scottish Government.
Muirhead says the Discovery application makes it easier for each health board to benchmark itself, and drill down to patient level to help improve health quality. “If you have, say, higher readmission rates than other geographical areas, why is that happening? If you have more ‘did not attends’ [DNAs in NHS jargon], why is that?”
His colleague, Jamie Gray, principal information development manager at NSS, recalls how they realised that their users were so used to serving themselves with information in their daily lives on smartphones and tablets that it made sense to deliver information in the same way to them in their working lives, using data visualisation tools from the likes of Qlik and Tableau. “This is browser-based. It’s not for people who are specifically interested in data for data’s sake. It’s more about turning information into action for medical staff,” he says.
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They wanted to shape the product in a way that involved the ultimate users of the application in what it did and what it looked like. And because the technology enables health workers with appropriate access to drill down to patient level, it also has to be secure. At the time of the technology choice, that ruled out a cloud system, Gray says.
“The NHS in Scotland is reticent about putting data in the cloud, so we have developed a robust security model with restrictions all the way down and across the system. It is very granular. We looked at some of the things health boards in England are doing using Qlik, using the cloud, and those did look great. But we have gone for a more traditional model with the information stored in our current infrastructure and accessed via an encrypted NHS N3 network. There is an element of compromise there since it would be good to have doctors accessing information from their iPads from home.”
The application, which Gray christened Discovery, was created in April 2015, and hard-launched in the NHS in Scotland in September 2015. From April the development team have been getting feedback from users. “There was a keen sense of user ownership through that,” says Gray. “It is, however, still a brand new baby, tottering on its feet, and we now have to keep that momentum of engagement going. In recent months it has continued to evolve and expand in terms of content and functionality in response to users’ information needs.”
Muirhead says that the agile mode of development that came with the Tableau development and deployment has made the relationship with the in-house IT team more collaborative and productive. “In the past we have had to specify everything to our IT colleagues in advance, which is not the most enjoyable of experiences for either the business or the IT side.” There are 150 developer licences among non-IT staff at NSS, and three full-time employees maintaining and developing the system.
When it came to the technology choice, Muirhead says the pan-NSS evaluation team ran a six-month trial and put the final four contenders “through the wringer”. Cost was not the deciding factor, he says, but “more about getting the right product for how we use information”.
After spending about a year researching the data visualisation field, they signed the contract in March 2014.
Gray says that with Tableau there was “very little coding required on our side. We needed a visualisation tool with some analytical capability. We didn’t need a full business intelligence solution.
“It complements what we’ve got and it will also evolve with the changing information needs of the NHS in Scotland. When and where appropriate we will explore some other options that can be done with the technology, but at the moment our community feels comfortable with what we’ve got.”