As HTN’s focus on technologies and strategies to support ICSs continues, Graphnet – a supplier of shared care record software and population health solutions – shares a recent, high-profile case study to illustrate the important role that high-quality data and analytics can play going forward…
The title of the latest strategy document from the Department of Health and Social Care – Data saves lives: reshaping health and social care with data – makes it very clear the role trustworthy data-sharing will play in the transformation challenge ahead.
For Integrated Care Systems (ICS), shared information and combined intelligence will be central to understanding where to target resources and interventions, as well as understanding the outcomes of those interventions and co-ordinating care across settings. Data and analytics will provide the insights that ICS Partnerships and NHS Boards need if they are to take action and meet the new triple aim – improve outcomes, tackle inequalities and enhance productivity.
The theory is increasingly well-understood, but in practice, it is still very early days. Those care systems furthest along the intelligence-led integration path are using insights to transition from optimising the episodes or ‘pitstops’ of care to using smarter pathways for better ‘journeys’ of care.
Cheshire and Merseyside is one of these care systems. Its Combined Intelligence for Population Health Action (CIPHA) programme was established in April 2020 when, in the first days of the pandemic, emergency response teams consistently reported a lack of timely, linked data to support system-wide actions. Graphnet was contracted to provide the integrated regional intelligence platform, with real-time analytics, dashboards presenting information to allow prompt co-ordinated actions, and the data to be able to predict, prevent, identify and control COVID outbreaks promptly.
A collaboration involving the NHS, local government, and University of Liverpool, established CIPHA quickly on a central principle of combining efforts to close the data-action gap across the NHS Cheshire and Merseyside region. Other parts of the North West region have now joined the CIPHA expansion programme. CIPHA enabled the world’s first insights into voluntary ‘mass testing’, enabled a national pilot of re-opening live events linked to real-time public health actions, and is helping target vaccination and NHS COVID-recovery.
With around 500 stakeholders, the cloud-based CIPHA system links health and care information on 2.6 million Cheshire and Merseyside residents, drawn from all parts of the care system, including from 15 acute trusts, 359 GP practices, eight community trusts, three mental health trusts, nine local authorities and emergency services. This information is combined with information from multiple national data sources, such as Public Health England’s data on COVID cases and tests, NHS Pillar 2 testing data on a 30-minute feed, NIMS vaccination extract, NHS Improvement COVID admissions reports, and ONS death rates.
CIPHA uses this information to deliver intelligence and analytics in a series of real-time and near real-time dashboards, designed in collaboration with the health and care system and Graphnet. The dashboards cover three broad areas: capacity and demand; epidemiology and population stratification. In addition, nearly 100 reports are provided to over 1,000 users across the system.
There are multiple users benefiting from interaction over the shared intelligence used to drive care decisions, support operational responses, predict demand, explain variation in outcomes and respond to emerging situations. It is integral to mutual aid planning and provides data for research. CIPHA data is also an important part of national understanding about coronavirus and policy.
Some CIPHA uses:
- Provides population stratification by age, sex, deprivation and ethnicity to help move from just describing inequalities to programming equity in progressive implementation of NHS 20/21 planning and operational guidance.
- Targets specific cohorts for direct care and measures the impact of actions. This includes pulse oximetry@home programmes and, more recently, virtual ward programmes to optimise the management of long-term conditions, such as blood pressure monitoring in hypertensive patients.
- Provides daily stratified insight into flu and COVID vaccination progress, used for targeted campaigns in areas of lower uptake.
- Delivers daily local and national reports on COVID cases and deaths, sliced by characteristics, and intelligence on capacity and admissions, used to direct operational responses.
- Delivers daily intelligence and analytics on epidemiology for real-time national and local planning imperatives – CIPHA works with NHS and public health teams in co-creating dashboards and reports.
- Delivered COVID-SMART Community Testing evaluation, now informing UK policy and influencing international policies. Reports were updated three times a day, seven days a week, with analysis focusing on test and case counts, geographical analysis by ward and test site, and population characteristics such as age, sex, deprivation, ethnicity and test reason – guiding deployment of testing centres and communications to change testing with different restrictions, variants and epidemic phases.
- Playing an important part in the national Events Research Programme to inform reopening of live events – and uniquely with CIPHA, testing real-time ticket-to-test data-driven outbreak prevention and control measures.
Enabling the world’s first voluntary ‘mass testing’ for people without COVID symptoms
The Department of Health and Social Care (DHSC) approached Liverpool City leaders on 31 October 2020 offering COVID-19 testing for everyone living or working in Liverpool, regardless of whether they had symptoms. As the leaders had been preparing CIPHA they had the ability to stand up the essential command-and-control centre with a single source of truth for different local government, NHS, army and research agencies to coordinate actions at unprecedented pace and city-scale.
The initial testing centres and communications to the public were stood up in five days, alongside the remaining dataflows (Pillar 2 testing 30-minute feed) and dashboards. A quarter of the city’s population were tested in a month from 6 November 2020. By mid-December, the ability of the system to detect new cases had risen by a fifth and case rates had fallen by a fifth.
The army then pulled out and the city reopened into a lower tier of restrictions than any other large city in England. Liverpool hotels were filled with large numbers of people from London where the alpha/Kent variant was surging. Liverpool then experienced a steep alpha surge and pivoted its ‘mass testing’ capacity in the subsequent national lockdown to people having to leave home for work. Also, to emergency service personnel to help them avoid quarantine by using daily testing instead.
CIPHA supported rapid operational changes, such as moving from national to local messaging to get a PCR test after a positive lateral flow result, in concert with CCG staff, NHS Informatics Merseyside and NHS Choose and Book over a matter of days, seeing confirmatory PCR uptake move from 19% to 79%.
CIPHA showed that those living in deprived areas were less likely to get a test and more likely to get COVID. By sharing anonymised data with university researchers, CIPHA also helped show – through linkage to consumer data on internet and digital technology uses – that digital exclusion was an even bigger barrier to testing than deprivation.
Qualitative researchers ran surveys and focus groups showing that fear of loss of income was core to low testing uptake in deprived areas. By bringing a combined, mixed-methods intelligence team together, CIPHA helped generate actionable insights not possible by data-led approaches alone. This culture of rapid response and combined analysis is now extending to targeting vaccination and planning COVID-recovery for the wider ICS.
Further, groups of data scientists involved in CIPHA are working across regions and in national groups such as SAGE and SPI-M to develop better predictive models that CIPHA is embedding in dashboards. An infrastructure for multi-region federated analytics is being tested with OpenSAFELY and vaccine-outcome surveillance.
Iain Buchan, Professor of Public Health and Clinical Informatics at the University of Liverpool, who led evaluation of these national pilots, said: “CIPHA changed the landscape from islands of analytics and reports to a community of combined intelligence with near-real-time data. This partnership of trust over shared data, between integrated care system agencies and the public, made internationally important COVID-19 responses possible.
“Looking forward, I think it is feasible, and arguably essential, to build a national grid of powerful, intelligence-led integrated care systems that can close the gaps between data and actions in the ways that CIPHA has demonstrated.”
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