Expert view: Dr Alex Horne

Dr Alex Horne

For decades, the focus of healthcare business intelligence has been on acute hospitals, almost to the exclusion of all other sectors. Even when other sectors began to acquire systems, the tendency was to start with primary care, and then commissioners, and to leave mental healthcare as something of an afterthought.

What has changed that has been the move towards foundation trust status. More than half of all mental health trusts have now achieved foundation status, putting them on a par with their counterparts in the acute sector.

As foundation trusts, they enjoy increased autonomy; but they also face a requirement for improved management and more robust financial control. This, in turn, poses a significant and unique challenge for mental health trusts.

Bridging the geographical divide

Mental health trusts can operate over hundreds of sites across large geographical areas, and across multiple local authorities and primary care trusts. A large proportion of the work carried out by mental health hospitals takes place on neither an inpatient nor an outpatient basis, but through community contacts.

This poses a challenge in ensuring unified and accessible clinical records – multiple case notes at different sites can make it difficult for health and social care teams, clinicians and managers to share patient data effectively to deliver the best possible care.

The deployment of electronic patient record systems will improve accessibility, but challenges remain, both in developing more flexible systems that can be adapted to the needs of the clinicians who use them, and also in educating clinicians on these new systems and the way in which data needs to be recorded.

The approach we have taken at North East London is to deploy a single data warehouse from Ardentia, to ensure the information silos that can all too easily exist within the distributed geography of mental health are broken down.

A web-based approach also means data can be shared more easily. Improving access to data in this way will not only improve care delivery, and meet management reporting requirements, but is also a fundamental building block in giving clinicians the ability to lead, in line with the recommendations of Lord Darzi’s Next Stage Review of the NHS.

Business intelligence for business processes

Foundation status requires trusts to function on a robust and clear business footing. Greater autonomy brings with it the need for more far-reaching management decisions, based on reliable evidence and giving clear understanding of the issues that need to be addressed.

There is also a requirement for far more detailed financial reporting, a mandated requirement from Monitor, which oversees foundation trust applications, regulates performance and requires the development of service line reporting to meet these financial requirements.

The challenge for senior clinicians is to understand the financial and management issues related to the care being delivered, in order to ensure more robust management. They need accurate information on resources used, quality of care and financial performance, and to access this, they need powerful business intelligence solutions.

Dealing with complex patient pathways

Many patients with mental health have long-standing and complex needs. Unlike acute physical care – where clear-cut pathways determine the intervention needed – the challenge in mental health is to bring the relevant services together at the right time, according to patient need, ensuring the appropriate care bundles are delivered.

Within the treatment of a single patient for a single condition, there may be moments when the patient moves from one bundle of care to another. This would be the case, for example, when the patient is being treated for a sub-psychotic condition but goes through a psychotic episode in the course of treatment. This all impacts on resource usage and the costs involved.

Mental health trusts therefore require good quality data on multiple patient episodes and need to reason in terms of real pathways of care, in order to develop comprehensive reports and develop the right care package.

Business intelligence systems must be able to bring together and link data from many different systems, to build pathways that identify community contacts, therapy sessions, outpatient attendances and so on into coherent pathways, to be analysed as a package.

Bringing it all together

That kind of complex care then needs to be married with financial data drawn from our accounting systems so that we can provide service line reporting and meet the management requirements set out by Monitor.

Looking at the financial implications and management issues associated with the care delivered in this way also does something else that is profoundly important.

Just as it brings together data about the healthcare activity we carry out – the inpatient stays, outpatient attendances and community contacts we deliver, with data from our accounts – it brings together the clinicians who provide the care with the finance managers who are answerable for the performance of the trust.

Creating the clinical leaders of the future

The Department of Health, guided by the recommendations of the Darzi review, is committed to bringing senior clinicians and consultants to the very heart of decision-making.

Doing this requires clinicians to have an understanding of financial and management issues; and the resulting challenge for trusts is to provide the necessary data. This is where business intelligence is crucial, bringing together information on care delivered, outcomes and the financial costs attached.

North East London NHS Foundation Trust is working closely with Ardentia to ensure we have good quality service line reporting that provides the data we need on cost, activity and outcome.

As a result, for the first time, clinicians will get a more comprehensive understanding of the care delivered, empowering them to make more meaningful decisions, and to work more closely with commissioners to shape future healthcare delivery.

Give senior clinicians the data they need, and you give them the capacity to lead, to function in a business manner as proposed in the Darzi review – and, as a result, to transform care delivery and meet the needs of those who need it.

Links:

North East London NHS Foundation Trust

Ardentia