Ram Rajaraman, healthcare and life sciences lead at Quantexa, explains why we need to get the basics right around data infrastructure before introducing new proposals to the NHS.
The publication of the 10 Year Health Plan has left everyone with the same question: “What’s next?” The new proposals are ambitious and promising at their core, but the path to execution won’t be unveiled until at least September.
Introducing a system where neighbourhood health centres are the first point of contact for many patients is a positive shift towards reducing the pressure on overcrowded hospitals and ballooning elective waiting lists. Patients will be able to receive tests or scans closer to home.
But the reality is, NHS data is not currently in the place it needs to be to transition to a neighbourhood health centre system. And the systems that are supposed to connect are not interoperable.
Why is this an issue? Because if we’re to successfully transition to a neighbourhood health system, the centres need access to the same patient data themselves and be able to feed back any additions into the same system accessible across the health service. This will provide clinicians with a patient’s entire appointment, care and result history, meaning the patient no longer needs to retell their story at every appointment.
The comprehensive solution needed to connect these disparate health centres doesn’t yet exist. And while the NHS Federated Data Plan (FDP) is an attempt to bring all of an individual Trust’s information into one source, it is not currently interoperable with the other NHS suppliers at play.
The government is proposing to build a new “single patient record” (SPR), which will encompass a patient’s full medical record and journey, using the NHS App as the digital entry point. This is the right idea – but NHS data isn’t ready.
The single patient record in practice.
The SPR is essential to facilitate the shift from analogue to digital. But for this to be applied, NHS data first needs to be cleansed and connected.
The health service’s dataset is vast – there are an estimated 55 million primary care records and 23 million patient-episodic care records – but tends to be fragmented, siloed and of variable quality. For example, patient records often contain missing information, such as multiple GP registrations or incorrect information provided by the patient in A&E. When ingesting these key data sources, it’s essential to match the patients to their ID numbers, ensuring consistency across all points of care, and removing duplicates.
Once the data is cleansed, it can be connected within the context of each individual. By using approaches such as AI-enabled entity resolution, the SPR can bring in all components of a patient’s health data, connecting disparate datapoints across primary, secondary, community and mental health providers. Currently fragmented, patients are often relied on to bring their own appointment history with them, digging out test results and making physical photocopies to bring new care providers.
But I would argue that the SPR is just the starting point to building a Citizen 360 record. By taking a 360-degree view of an individual and matching it with their citizen records, we can get a real-world view of connected data, enriched with contextual information to support patient outcomes and improve prevention in individuals and populations.
This would look like bringing in local council records or other pre-existing public data. It would include social care, benefits (Department for Work and Pensions), company records (HMRC and Companies House), educational records (Department for Education) and housing records from their local authority. By bringing in both NHS data and wider determinants of health, we can get a full context of an individual’s medical history.
What’s more, this data can inform research supporting population health. For example, if we take these 360-degree records of patients and feed them into a digital twin, we can spot trends in population health determined by region or other social determinants. Not only does this help hospitals with resourcing, but it can help prevent health events before they happen, supporting a tangible shift from treatment to prevention.
Making neighbourhood health centres effective
When the SPR is built, we can start to shift care to the left through neighbourhood health. By joining up patient data from the neighbourhood health centres applying entity resolution, patient records across multiple NHS Trusts, local authorities, community providers and other public bodies can populate the unified Citizen 360 record in real-time.
Not only would this save NHS staff from unnecessary administrative burden, it would enable patients to use better-connected neighbourhood health centres, benefitting staff and patients alike. The NHS can finally become the data-enabled landscape that it needs to be to deal with the rising demand of healthcare.
But for the SPR to exist, we need to prioritise getting the basics right around NHS digital and data infrastructure before introducing the new proposals, or put another way, sorting the backend before the frontline. There’s one thing that remains clear from the plan: The system, and its people, are welcoming of the long-promised digital NHS and it’s time to confidently say goodbye to the analogue.
