Rachel Elliott and Matthew Franklin are reporting on behalf of the Medical Crises in Older People (MCOP) research team. Read the first part of their blog on identifying health & social costs here.
As part of a programme developing and evaluating care in older people, our recent study in Age and Ageing reports health and social care costs over a three month period for older people discharged from Acute Medical Units (AMU) by applying unit costs to patient-level data obtained from six different agencies: hospitals, primary care, social care, mental healthcare, ambulance services, and intermediate care. This is the first study to do this in England, but obtaining resource use data from individual services for this analysis took months, which was costly and of no use for real time patient management.
Collecting data from electronic administration records (EARs) is not simple in the National Health Service (NHS) in England, because there are many different systems used by different agencies. Access to each requires specific permission and procedures to ensure data security. Many systems are not interoperable (cannot exchange information between systems). This causes difficulties for clinical teams integrating and tracking patient care and for researchers measuring resource use and patient outcomes.
The different systems were designed for individual service requirements and data recording. Using primary care as an example; we collected data from general practices (GPs) using five different EAR systems designed by four different software developers: SystmOne designed by TPP, Synergy designed by Synergy, Vision designed by INPS, EMIS LV and EMIS PCS designed by EMIS (although EMIS Web is the most modern EMIS system). Many of these systems are used without interoperability with other practice or NHS service systems, but there is technology which enables record sharing.
Keeping with primary care for example, the GP2GP service offered by providers such as EMIS, INPS and TPP provides an electronic method by which to transfer patient EARs between practices. SystmOne offers interoperability through the national broadband network for the NHS via a secure virtual private network (VPN) token, with patient records being stored on a secure central server. SystmOne is a good example of progress towards real time data linkage between services, but we are currently unsure how long it will take to fully operationalise this or similar technology across all agencies.
Health and social care data meet many of the defining parameters for big data (large in volume, variety of data formats, and often needing to be accessed quickly). Current lack of interoperability effectively segregates the services provided within the NHS and social care. Interoperability between systems is essential to allow integration between services. Only then will these large, complex, real-time datasets have potential to enhance real time patient management.