The lasting legacy of a transition from data to wisdom

Because it is a complex setup of a lot of different organisations, it has been difficult for the health system in Dorset to pull data together in any kind of timely way. Now a new technology initiative is proving invaluable and has helped in the response to COVID-19.

The power of data

When Dorset healthcare system began writing its digital strategy in 2016, the team knew data would be one of the cornerstones. “A lot of power can be taken from data,” says Stephen Slough, CIO at Dorset Healthcare, Dorset County Hospital and Dorset CCG. “If we can start to pull data together from different sources, start to develop insights and intelligence, it will enable us to change the way we are approaching treatments, how we interact with and care for our patients, see whether drugs are proving successful and the factors which impact how healthcare is perceived and delivered.” 

At the time, many silos of information existed across the county’s healthcare networks. Information was still seen as “internal” knowledge by organisations and the different applications, with separate data and information, meant there was very little collaboration.

“We set the ambition of having a data warehouse where we could collide all these different datasets and allow them to be analysed,” says Slough. Rather than use expensive consultancy companies which present analysis but “data is black boxed”, Dorset was keen to develop sustainable capabilities inhouse. This way, it could bring its own expertise and clinical understanding to the data.

Slough explains, “Within our organisations we have intelligent experienced people who know how to handle the data and most importantly understand what changes the data and why. If we could invest in them and upgrade their skills and abilities, they can do what no one else can do.  What we needed was a framework and a setup of technology pieces that we could plug together.”

Choosing Azure and Power BI

Analytical leads from across the integrated care system (ICS) came together to assess the opportunities. It took time to make the right decision; any system had to be scalable, configurable, and sustainable in terms of affordability.  

“We needed something that was going to be easy for us all to use and Microsoft was that platform,” says Slough. The strong relationship between the NHS and Microsoft, the familiar interface and the easily accessible training were all important factors in the decision to use the Azure and Office 365 platforms. “Having all that with one provider so it is all seamlessly integrated has got to be the best answer,” Slough continues, “it fits strategically with the direction we are setting, which is really important.”

The Dorset team set up an Azure tenancy which gathers patient data from local NHS Trusts and the two Local Authorities for Dorset and combines cross-tenant identity between them all. Azure Data Factory is used to process the data, making it available to Azure Synapse and Power BI reporting services. 

Changing the culture

Initial work at the Clinical Commissioning Group (CCG) to pull different datasets together in a way that would deliver value to the organisation required a considerable cultural change. James Woodland is the Deputy Director of Business Intelligence at Dorset CCG. He says, “Shifting organisational cultures away from consuming data using Excel and in pdfs was a slow process. Power BI helped us with that journey at the CCG.”

The Power BI journey within Dorset began with cross organisation performance reporting. The CCG pulled together various KPI data from across the Integrated Care System to develop performance scorecards. Rather than having multiple different tools to monitor performance in multiple different formats, the reports were transformed into drillable dashboards. Woodland says, “that was a really easy win that very much started a culture of self-service analytics and how to consume information in a more timely way.”

Slough cites a further example of two GPs who collaborated on some of the dashboards and toolsets that were developed. Previously they had to extract data and send it to a University to analyse and the data was then returned to them in a spreadsheet. Slough says, “This was clearly unsustainable and incredibly inefficient so, in that early phase, the team created a dashboard toolset for that data. Immediately they started to see the benefit and became advocates for the solution as well.”

Woodland says, “The Executive teams in different organisations became familiar with seeing data presented in multi-layered visualisations and this created demand within many partner organisations.” 

A dashboard for COVID-19

The burgeoning adoption meant that by March 2020 the data sharing analytics platform was already well established. It was linked through the various ICS partners and all of the interlinking councils and foundation trusts.

“We got the call a couple of weeks before COVID really started hitting asking whether we could use our linked-in datasets and our linked-in people to build a COVID system report,” reports Heather Case, the Intelligent Working Programme Manager at Dorset Intelligence & Insight Service (DiiS). 

The DiiS team responded quickly and the dashboards were developed within a couple of weeks. 

Case says, “As we collectively started to know more about Coronavirus, we could be a bit more practical about what we were likely to want to know, the groups that would be most impacted, and which of our services and our workforce would be most impacted. We started building something that was far wider than just trying to track the disease.”

Responding in a different way

Patient histories were overlaid with insights from NHS England about the different vulnerability groups, taking into account different nationally recognised clinical markers for individual patients. This could then be used to mobilise teams and begin to deliver patient care in a different way.   

While data is anonymised at the ICS level, at a GP practice level the system operates as, amongst other things, a case-finding tool. Woodland explains, “GPs can, in a simple, user-friendly way interrogate the system to identify lists of vulnerable patients who they wouldn’t have been able to identify before.”

Furthermore, non-emergency ambulatory 111 service telephony information was integrated with Primary Care data. Case says, “This added another layer of data, allowing for more predictive analytics as well and trying to provide a bit more foresight to partners.”

Slough says, “The response the team were able to put together over COVID-19 is just phenomenal. The power of data is now being recognised.”

Real time is a “game changer”

In previous emergency situations when up-to-date information was required, it had to be collected from each organisation in a spreadsheet or Word document every morning. It would then be collated centrally into a common format to be shared. This time around, the data was immediately available. No matter how busy Trusts became, the data would be pulled from all the various sources automatically into the data warehouse from where it could be reported on and analysed.

“That’s been a bit of a gamechanger,” emphasises Slough. “Our silver command incident management call was meeting seven days a week and they have had up-to-date data seven days a week, regardless of how busy organisations were. There’s no reliance on people to send the data in, the data is just collected. If somebody’s got a question about mortuaries or how Care Homes are doing, the data is here – so it’s at your fingertips, which is how data should be.”

Patient care & population health management

Regular development hasn’t stopped, even during the pandemic.   The work to assess the population’s needs and support networks in designing care pathways and to reduce variations at the local level and at the integrated care system level is ongoing.

Dorset can now analyse comprehensive patient care records dating back to when they are first created in the county. This represents a huge wealth of data about people’s histories, how they’ve been treated and how they’ve responded.  

Dorset is now surfacing information about the way treatments are being provided, supporting clinicians to make positive changes for the benefit of patients.  Slough explains how, when inconsistencies in medication were spotted for a patient in North Dorset, a review between primary and community care was organised which resulted in changes to his medication. “The changes brought a significant improvement to his quality of life and this gentleman in his 90s was able to get back out on the golf course again,” relates Slough.

Data is also helping to drive efficiencies and conserve precious NHS resources. Work to understand high-intensity users has revealed there’s often similar patients in those case mixes, says Woodland. “We’re able to very rapidly put that together in a patient list for GPs to review,” he says, “So practices within a network can quickly organise a network-level service. We can reduce the amount of GP resource needed almost overnight and we can create a lot of headroom and capacity within primary care.”

Expanding regionally

The potential to reduce pressures on the NHS is compelling. Different datasets and different views offer huge potential. “We were always looking back. We’ve never had the opportunity to get to a place where we’re actually looking at the data in real time across different organisations, across different pathways,” Woodland says. “We’ve now created a scalable platform so we can all be on the same page and start to look at value-add. We can genuinely start to move towards getting a bit of foresight; getting towards predictive analytics and proscriptive analytics.”

The potential to use patient data for research is also exciting, although this will require going back to the public for consent. The service is now being rolled out to regional partners. Dorset will be providing this service into the Cornwall STP and is providing consulting support for another STP in the South West region.

“We’ve upskilled our people, we’ve supported their growth with the training. Power BI is becoming the default presentation layer and its working,” says Slough. “Now our community of practice is growing. These are easily adoptable skills for people with the right mindset. A development that somebody creates can benefit teams elsewhere and that’s the key benefit we’re looking to leverage with our colleagues in Cornwall. The development capabilities have almost doubled – that will be a really huge advantage for us all.”

Working with other public sector partners

The range of use cases continues to expand. Case says, “We’ve been working with other public sector partners too. We’re having conversations around safeguarding of vulnerable children and adults with Dorset police, for example, and also with the fire service about linking with them in the work they do to deal with dementia.”

The team is augmenting health data with mental health and social care information and pulling in local authority information – opening up new possibilities. 

“What we’ve now got is pretty awesome,” Slough says, “It’s been hugely successful and it’s just going to keep going from strength to strength.”