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04.07.18

Connected health cities

Source: NHE May/June 2018

Professor Niels Peek, director of Greater Manchester Connected Health City, tells us about the perks of using patient data and digital technologies to rapidly improve our health service.

In a society where information is the currency of choice, patient data gives us the capability to redesign health services and better tailor them to the needs of populations and individuals. Connected Health Cities (CHC) is a government-funded programme that aims to create ‘learning health systems’ in the north by harnessing data that is routinely captured by health services, applying advanced data analytics methods and accelerating digital innovation in the NHS in order to deliver better outcomes for patients and communities.

The programme covers four regions (Greater Manchester, North West Coast, Connected Yorkshire, and North East and North Cumbria) and has an extensive public engagement programme that addresses the use of health data for service redesign. Furthermore, it aims to accelerate business growth in the digital health sector in north England.

Learning health systems aim to use every opportunity to learn and improve health services by harnessing the data that is produced as a “side-effect” of everyday health service delivery. For instance, electronic health records capture all 2.7 million drug prescriptions that are issued in English general practices on a daily basis. That gives the opportunity to monitor the long-term effects and safety of those drugs because the same records will also capture future health problems and outcomes for the same patients. Instead of running expensive pharmaceutical trials and cohort studies,  we can take advantage of this data to build up valuable knowledge about medications, rooted in real-world clinical practice.

The CHC programme is not just about producing new knowledge, but also about deploying that knowledge in clinical practice to enable rapid improvements in care services and health outcomes. Historically, innovations have taken up to 17 years to become adopted in routine care practice – if they made it to practice at all. At this rate, discoveries that were made in the early 2000s are yet to be implemented in the NHS, which means they are likely to be outdated by the time they are deployed.

This well-known inertia of healthcare systems is increasingly threatening their sustainability as populations and prevalent diseases are changing apace. The learning health systems approach aims to dramatically reduce the timescales for adoption by creating mechanisms for rapid deployment of new knowledge and insights through digital interventions. In contrast to traditional, paper-based knowledge dissemination and deployment strategies, digital technologies can provide knowledge as a service that is dynamic and responsive to change.

A good example is found in the stroke pathway, one of the key clinical pathway exemplars in the Greater Manchester CHC. Recent research shows that some urgent treatments, including reverse blood-thinning drugs, quickly lowering blood pressure, brain surgery and limiting do-not-resuscitate orders can reduce mortality rates in patients with strokes caused by bleeding into the brain.

Stroke researchers at Salford Royal NHS FT have developed a care bundle that implements these strategies and have shown that it has the potential to reduce mortality rates by 25% in patients with these types of strokes –                resulting in two saved lives per month in Salford alone.

We are currently rolling out this care bundle using a mobile application across all specialised stroke units in the region and aim to deploy and evaluate it nationally in 2019. Crucially, further insights in optimal treatment of bleeding strokes can be incorporated into the app at any time.

Indeed, those insights might derive from the deployment of the app itself, closing the cycle that is characteristic of learning health systems.

 

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