From across the pond - The missing link to population health in the NHS

Dr. Paul Grundy
Thurs 19 Oct 2022
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According to industry surveys, 92% of Americans feel that changes are needed in the US healthcare system. Yet, recently when my colleague from the UK had the opportunity to visit the US along with chief digital information officers and chief clinical information officers from Integrated Care Systems (ICSs) and other healthcare organisations, they learned more about what accountable care organisations (ACOs) are doing and why it’s working.

Despite the challenges in US healthcare, some of the most sophisticated ACOs have evolved out of the system and are succeeding— because of their focus on the key goal of a healthcare system—providing higher value care. As US health plans and providers incorporate and apply social determinants of health (SDoH) data and work towards unifying all patient data in a single record, they will have a more sustainable path to providing whole-person care.

The UK healthcare system has implemented the Summary Care Record (SCR)—an electronic patient record like the EHR in the US—which enables them to share data between primary, community, secondary, and tertiary care. As with ACOs, the National Health Service (NHS) is focused on improving the patient experience, optimising health outcomes, and incorporating innovative technology to help them achieve their vision of helping clinicians to work more efficiently.

Progress and next steps in the UK healthcare landscape

According to a Deloitte study on the future of UK healthcare, the principles critical to future proof the NHS are “developing open standards, having a secure identity and interoperability standards, ensuring the right data gets to the right place at the right time; and that services are designed around user needs”. Digitally-enabled care is expected to go mainstream across the NHS, advancing to full digitisation by 2024, helping clinicians to work more efficiently, improving the patient experience, and optimising health outcomes.

Although the UK healthcare system is the world’s best-known model of socialised medicine, as with many health systems, it struggles to balance access and cost. The NHS has been making steady progress in building an effective healthcare ecosystem. The Health and Care Act 2022, which was launched in April, is the next step to strengthen and accelerate the redesign of patient care for the decade ahead. It incorporates the key principles of working together to integrate care, reduce bureaucracy, improve accountability, and provide recovery support from the pandemic. It also emphasises the need for digital services to support and empower people to stay healthy and independent longer.

The NHS is taking proactive steps to build a UK healthcare system where patient data is readily accessible. Hospitals and clinics have been working with the first generation of Integrated Care Systems (ICSs) for the last four or five years with summary care records which contain important patient information, created from GP medical records. They are used by authorised staff in the areas of the health and care system involved in the patient's direct care. However, they are yet to provide completely secure online access, with personalised and relevant health information, and digital tools that meet the growing expectations of their consumer patients.

Managing the care gaps

The NHS now has 42 ICSs which are responsible for authorising healthcare services across the spectrum including ambulance services, health and social care, community mental health, and wellbeing support for identified populations. They are the foundation to promote effective improvement in quality of services, innovation, and integration leading to an overall improvement in health outcomes. How the ICSs are used—their key use cases—will help determine the technologies required to run these services smoothly.

To deliver on the NHS vision of enabling people to live healthier lives, the ICSs must be backed by a technology that enables them to deliver in the same way ACOs deliver on the promise of sharing information and providing cost-effective treatment. The existing system of SCRs wasn’t built on a modern technology infrastructure, which limits its ability to scale for the future.

The missing piece in the current UK healthcare system IT architecture is a unified data platform, which is absolutely essential for effective population health management because it provides the foundation for effective digital transformation and care coordination.

How to solve the end-to-end problem

Over the past 40 years working in healthcare technology across the globe, I’ve seen how the UK healthcare ecosystem has matured. So, while there has been a lot of progress, there is still the need for a single end-to-end platform that integrates all data and can offer a 360-degree patient view, which healthcare IT has not been able to solve. They provide a component of population health analytics, care coordination, or telehealth, but they are still working in silos. Health systems don’t have the platform to tie all the disparate systems together to provide a unified patient record—which is really at the centre of being able to provide the US approach to accountable care.

Integrated Care Systems are reshaping the UK health system in a way that can’t be done in the US because the UK has an active law in place that enables us to do that. There has been a lot of activity over the last few years around high-level population health management, i.e., identifying and stratifying a population to identify care gaps. The UK healthcare system is working to develop mechanisms within the ICSs that improve care coordination because currently there are no technology solutions that efficiently enable managing patient data.

We’ve heard it before, but once we have a holistic view of the patient data, we can provide the analytics and the integrated workflows that allow smart automated care coordination, patient engagement, and outreach. We can manage a population, stratify risk, target the right patients for the right treatment at the right time, with the right outreach at the right time and measure the outcomes. That's the bit that's missing here.

Going the last mile to close the gap and enable better population health management

Right now, we have the analytics tools to identify and validate the population to understand the care gaps. But then many caregivers and clinicians ask—“now what”? They don’t have the data platform technology to connect the dots and make a difference in efficiency, effectiveness, or outcomes. They want to know how they can apply what they’ve learned from the analytics.

There's not really much point in delivering analytics data if people can't actually do anything actionable with it. For us to move beyond the silos into doing something actionable, we need enabling technology for digital transformation to fill the gaps in capability, technology, and transformation.

Certainly, it's not easy or something we can do in a week, but we need to think long-term even to make a short-term impact. The importance of integrating technology with healthcare operations has never been greater, and with the tremendous amount of insights we can generate from disparate resources, it's time healthcare leaders delve into this rather untapped universe of possibilities.

Final words

More and more organisations are ramping up their healthcare technology operations, but they should keep in mind what they hope to gain in the near and long term. To cultivate its benefits, organisations must always understand exactly for whom the technology is made and who it would benefit. While unnecessarily complicated technology would burden the providers, a one-size-fits-all approach for all healthcare stakeholders wouldn’t be the right way to go forward either.

An ideal technology suite should be easy to comprehend by the care teams, save them time, increase diagnosis accuracy, and put patients at the centre of care delivery. It's that simple—providers and patients are the two sides of care delivery and anything that helps one, helps the other. I often emphasize that technology is merely our assistant, but can be life-changing if implemented correctly.


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Tags: UK
Dr. Paul Grundy
MD, MPH, FACOEM, FACPM Chief Transformation Officer, Innovaccer

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