IT DATA


from cardiac disease or which hospital has the best record in terms of length of stay or readmission rates?’” With this in mind, GP commissioners have to get on board with data technologies. “If you don’t pay attention to some of the underlying stuff that we, traditionally as clinicians, have sat in our ivory towers and ignored, saying ‘That’s too technical for me, I’m not really interested in that’, we’re going to get it wrong because it’s not going to be fit for purpose because we’re difficult customers,” says Dr Lloyd McCann, Harris’s medical director. “In order to make a good commissioning decision that is grounded in good data and good information, you need access to that data and information in the first instance,” he continues. “More importantly for clinicians is you need access to that data and information in a timely manner and in a manner that makes sense to you to make a good decision.” This isn’t as overwhelming as it sounds. Parslow believes the grassroots of the big data movement will be within individual localities. When the practice members of CCGs divvy out data to each other, it’s a step in the direction of integrated data not unlike the model seen in America with the Health Information Technology for Economic and Clinical Health (HITECH) Act and its meaningful use of patient data incentive (see box out).


SHARING IS CARING However, with so many systems across providers, sharing has proven a challenge: GPs haven’t always jumped at the chance of exchanging data. Jo Crossan, regional account manager at Oberoi Consulting, who works with PCTs to gather baseline data for specific disease areas, has experienced this, but doesn’t believe CCGs prescribing one software is the answer. “GPs are small businesses and they’re all independently run,” she tells Commissioning Success. “You have to allow the GP to choose what system they want to use.” She says it is feasible, however, for the data from individual systems to integrate into one big system for the CCGs. For example, she worked with a CCG in


Worcestershire that was trying to improve referral rates for orthopaedics that wanted all its GPs to refer through one central


system. “We looked at baseline figures for who was referring for what and helped them set up templates to make sure the referral contained all the right information,” she says. “Then we set them up so that every month the practices can send to the CCG just a quick search. They press a couple of buttons and it gives them numbers so they can keep an eye on what’s happening and support those practices that aren’t using the system.” The GPs weren’t entirely keen to share data from the outset, but once they discovered that Crossan was working for an independent organisation, they soon acquiesced. For some reason they felt more comfortable with a third-party than their own CCG. Dr McCann believes holding back like this is unacceptable if the NHS is going to deliver the Nicholson Challenge. “There’s a responsibility that’s going to come


JARGON BUSTER ‘Meaningful Use’ Act


As part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, in which the United States Department of Health and Human Services is spending $25.9bn to promote and expand the adoption of health information technology, every provider of healthcare in the US has to provide information to a set of published standards. The act sets meaningful use of interoperable electronic health record adoption as a national goal and incentivises providers to do so. Doctors who do not adopt an EHR by 2015 will be penalised one per cent of Medicare payments, increasing to three per cent over three years.


with being the commissioners of care,” he comments. “If we’re going to move to a truly value-based system, where we are measuring performance against outcomes, rather than process measures, people have got to be prepared to share this data.” However, according to Matt Murphy, MD of EMIS IQ, there are security implications to sharing data and successful information exchange is really about trust as much as it is for benefit. He believes sound information governance should be at the heart of any CCG’s data sharing policy, to mitigate any security repercussions. “It should address the balance between protecting the integrity and privacy of the patient versus the benefits to the community of shared data,” he says. Patients, he continues, usually welcome shared record access, as it delivers better informed cares. “Ultimately, it is for individual CCGs to decide the pragmatic way to achieve a shared patient record, in line with local needs.”


A FLEXIBLE APPROACH


The only way it seems adequate data sharing like the kind described above can be achieved is through flexible software. For this, the architecture is, in some ways, more important than the product. “If the solution isn’t right, but the architecture is, you can change the solution,” Parslow explains. “If your architecture’s wrong and your solution’s wrong, you chuck it all in the trash and start again.” With this in mind, he says commissioners need to be clear about what they want from any data system they procure. It should integrate easily with other systems and there should be no vendor lock-in. “In my mind, systems that are implemented and stay virtually the same in terms of functionality for the best part of 10 years cannot support today’s NHS,” he says.


So it seems no longer can


commissioners afford to put a finger in the wind and make decisions based on gut feeling or past experience. In future, more affordable decisions need to be driven by data. And to do this, clinicians and commissioning leaders must have access to a wide-reaching and integrated information system. Until that happens, real commissioning is at a standstill.


50 | WWW.COMMISSIONINGSUCCESS.COM


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