The annual conference, hosted by InterSystems at The Belfry, had even stronger meaning than when delegates gathered 12 months earlier to demonstrate ways in which genuinely joined-up health and care could be achieved. Mark Palmer, country manager for InterSystems in the UK and Ireland, highlighted how at the centre, the establishment of global digital exemplars (GDEs) and sustainability and transformation plans (STPs) had now created a national impetus around digital maturity and integration.
But it would be the frontline stories of NHS and care technology in action that would deliver the most meaningful and sometimes passionate debate on what joined-up care really means.
'Keeping mental health data secret reinforces stigma'
Dr James Reed, a consultant forensic psychiatrist and chief clinical information officer at Birmingham and Solihull Mental Health NHS Foundation Trust, told delegates it was time to "open the X-Files", especially when it came to mental health data. "Everywhere around us there are these mysterious unexplained files that GPs hold, that other hospitals hold, that other health providers hold, which really might as well be locked away in an FBI building because there is really no way we can get our hands on them. We know there is useful information that could help us treat the patient in front of us, but yet it is unobtainable."
With many organisations trying to strike the balance between privacy and making important information accessible, mental health is one area where information continues to be treated with extra sensitivity.
"Often you hear people talk about mental health data in hushed tones, as if there is something special, or secret about it," said Reed. "As a psychiatrist, I have always felt that it is a complete misrepresentation. I don’t see mental health data as being any different than any other type of health data. I don’t think information about one’s schizophrenia or depression is different in any way, or any more sensitive or difficult as information about your cancer or diabetes.
"Psychiatrists haven't helped this over the years, but if we make out our data needs to be kept secret, that disadvantages the patient, because all the other professionals involved don't have access to it. More broadly it disadvantages the system of care. I am keen on sharing the data whatever your diagnoses so that all health and care professionals involved get to see it."
Reed's organisation is now working as part of the MERIT vanguard, an alliance of NHS trusts in the West Midlands working in partnership to transform the way acute mental health services are provided, with an aim of establishing a common mental health record across the region. To be based on InterSystems HealthShare technology, this record, he says, might not stop at mental health, but could even extend to involve acute and GP information, with a reach across the West Midlands, paving the way for joined-up care not only regionally, but possibly nationally.
First mindsets around mental health data need to change. "If you are sick with a broken leg everyone gathers around you," said Reed. "If you are sick with depression everyone abandons you. We shouldn't play into that by trying to make out mental health data is different - that reinforces the stigma."
The cancer capital of Europe
David Walliker told the conference of the very real implications of "disjointed" care and the need for information flows across health economies. "Liverpool is the cancer capital of Europe," said the chief information officer, whose role extends across two trusts in the city. "If you get cancer in Liverpool you are more likely to die [as a result] than anywhere else in the country." Effective use of data is now seen as a key tool in moving Liverpool beyond this situation, and in addressing other significant variances in the region.
The ability to harness data for more effective care is certainly picking up pace. Royal Liverpool and Broadgreen University Hospitals NHS Trust, which was named as a global digital exemplar by NHS England, along with neighbouring fast follower trusts, is gearing up to deploy interoperable and digitally advanced systems in the near future. In particular, Walliker told delegates why the trust's new electronic patient record (EPR), InterSystems TrakCare, could not be deployed soon enough. Not only will this mean that the current challenges of maintaining 76 different clinical systems would come to an end, as they could be turned off, but that there will be a single patient record across 75% of adult activity.
"This is one of the few projects where I have got consultants asking me to do this quicker," he said. "They are desperate to have it in, they can see the power of what we can deliver with it." With ambitions to reach the equivalent of stage 7 of HIMSS digital maturity rating by April 2020, it was part of a strong programme of activity to make information accessible and meaningful. For Walliker, meaningful also meant thinking about flows of information with other providers in Liverpool - there was "no point spending money on making the Royal better and ignoring outside of the hospital walls".
Even inside the hospital there were new revelations to be had for clinical informatics by thinking beyond traditional boundaries.
A sepsis tool developed in Royal Liverpool and Broadgreen had the potential to save as many as 200 lives per year. But Walliker told the event, this was only developed by drawing on internal resources he had never previously considered. "We had a large high-quality resource in the hospital, in my development team whom we did know about and medical physics whom if I'm honest I didn’t know was there. They are the most ridiculously clever people. We are now tapping into that resource for our digital transformation as bringing them together with my developers is a dream ticket."
"It is scarily impressive what you can do with the right data - but you need people with the headroom to develop the right ideas," he told the event.
The headroom - the battleground for skills and NHS cyber attacks
Walliker's observation resonated with opening remarks form Mark Palmer - that there was now a "battleground for skills" in the push for digital.
On the one hand skills were needed to deal with real and immediate threats. Ken Mortensen, InterSystems' data protection officer, reminded delegates of the need to "deal with the unexpected". 2017's crippling cyber-attack had meant that words from data protection officers were now being listened to. Resilience against cyber-attacks and the ability to secure data was needed for trust. "If we don't have the trust of patients we are unable to deliver effective service or effective care," he said.
Dealing with cyber-attacks was about more than skills. For Graham Evans, paperless was a step too far in a world where threats like this are encountered. Evans, who as chief information and technology officer, has overseen the go-live of TrakCare at North Tees and Hartlepool NHS Foundation Trust, told the event that "the more digitally dependent we become, the higher the cyber security risk could become". He said: "My view would be that paperless is possibly a step too far. If we can get to very paper-light that would be really useful, mainly because in the event that something occurs such as a major cyber incident, something as simple as a piece of paper can help you through."
Meaningful data tools
Some of the thought leaders with the skills and vision needed to enable change made other appearances at the conference.
Bestselling author, campaigner, academic, and medical professional Dr Ben Goldacre, challenged the conference surrounding an over acceptance in the media of correlations in data, coincidence and actual causation. He also warned that academia had to do more to make their authoritative studies meaningful to frontline of the NHS.
"We have lots of data in the NHS but we deal with this incredibly badly at present," he said. "There is enormous amounts of funding for academics to sit down and do detailed projects that ask questions of no interest to anyone... which we then publish incredibly slowly in academic journals."
Goldacre, a senior clinical research fellow at the Centre for Evidence Based Medicine at the University of Oxford Software, had been taking a different approach to making data meaningful. His colleagues - a multi-disciplinary team of engineers, coders, academics and clinicians, had worked together to produce "live interactive data driven tools".
OpenPrescribing.net, was one such tool, which is now helping to identify prescribing variation across the country.
The idea surrounding practical uses of technology and data echoed throughout the event.
Dr John Payne, InterSystems' physician executive for Scotland, spoke about how data and standardisation could be used to enhance patient safety, how it had been used to reduce limb amputations, and how through the electronic patient record, information could be a driver for clinical change.
'My sister-in-law died a very difficult death'
Perhaps the most moving conference story of the difference data can make, came from Professor Julia Riley of Coordinate My Care.
"My sister in law died a very difficult death. Every time she, or my brother called for help, the default response was 'take her to hospital'. She had no control. All of the carers around her were distressed. There were unnecessary medications and medicalisations. She had all sorts of unnecessary investigations, even though she knew she was terminally ill."
Riley has led the Coordinate My Care programme to change this all too familiar picture for families, and to enable action before the point the patient calls for help.
With national statistics indicating that of the 500,000 people who die in England and Wales every year, almost half die in hospital - Coordinate My Care has helped to change this for end of life and urgent care patients in London. An intuitive, personalised urgent care plan is putting patient choice at the heart of healthcare, making providers aware of patient wishes. Of the Coordinate My Care patients who have sadly passed away, 80% have died in their preferred place. One in five are dying in hospital, rather than almost 50% doing so at a national level. Families can be confident that their loved one’s wishes are known and should be respected, without having to repeat the same information at times of distress.
With positive response, Riley asked delegates if they would adopt such a plan with their loved ones if it became available outside of London.
Work is far from complete in joining up health and care. But it is advancing. James Palmer NHS Digital's programme manager for social care, emphasised that his organisation is still working in close collaboration with a number of local government providers, despite the absence of 'social care' from his organisation’s new branding. Buy in for joining-up services and bringing social care along with the digitisation of health is there.
But there is a lot of work to do, the conference heard. Siva Anandaciva, chief analyst from The King's Fund, outlined a good many challenges in the delivery sustainability and transformation plans - clinical engagement, workforce, counter-cultural change, organisational design, and the ability to understand what good looks like, being just some. But despite the turbulent waters he depicted, Anandaciva remained an "optimist".
Perhaps summed up best by Mark Palmer, the conference showed that things were starting to happen and that meant tangible progress: "The agenda of healthcare has moved beyond strategy and plans to delivery, at last."
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