Getting the best out of population health requires learning health systems

A rapidly evolving digital infrastructure offers great potential for population health in the UK, but a “learning health system” needs to be expanded upon to take full advantage of its opportunities, speakers told a session on Rewiring Health Systems at Digital Health Rewired24 earlier this month. 

Professor Iain Buchan, associate pro vice chancellor for innovation at the University of Liverpool,  told the keynote session on the Integrated Care Stage that a full understanding of the causes of disease required better awareness of the social determinants of health. 

“We’ve had thousands of years of doctor-to-doctor communication as the basis of a lot of health information, and that works within parameters,” he said. “But we need a way of brokering the need to service in the future around the individual and their journey. The brokerage of needs to service implies that you’re continuously improving coordination of care for an individual and for a system.” 

Understanding how to collect and use “fine-grained data” gathered from a variety of organisations – including social care, local authorities, the charitable sector and even law enforcement –  to support the healthcare journey will be the main challenge for population health going forward, he added.

He traced the evolution of population health from the clinical audits of the 1980s and 1990s, using specialist registry data and crude predictive models to the learning health systems of the last decade, with their use of integrated care record data, fuller longitudinal prediction and practice-based evidence.

Looking forward to 2030, he said, this will necessitate use of wider civic health system data, multi-outcome prediction using causal machine learning and an intelligence-led system that is based on embedded research. 

Covid as a learning example 

Covid-19 provided a blueprint for how to use “action ready data”, Professor Buchan said, through the use of near real-time covid testing data for Cheshire & Merseyside’s 2.7 million population, which was linked to GP and partial hospital and social care records, allowing for the creation of dashboards for care, planning and research. 

Liverpool, one of the UK’s most deprived regions, was ground zero in October 2020 as Covid-19 deaths surged. It hosted the world’s first city-wide pilot for testing people without Covid symptoms in an effort to save “lives and livelihoods”. A quarter of the population volunteered for testing within a month, case detection increased by a fifth and the known case rate fell by a fifth; at the same time, hospitalisation fell by a quarter. 

The Liverpool pilot both highlighted the lower uptake of testing and higher infection rates among the most deprived and digitally excluded citizens in the city and led to community testing roll-outs focused more on the interaction of biology, behaviour and environment, including the recommendation of isolation payments for those unable to afford isolating. 

The concept of digital twins in healthcare – virtual models that can represent anything from an individual organ to a population as a whole – will help the healthcare system better predict clinical outcomes and their interaction with sociological behaviour.

Professor Buchan said such “health avatars” would allow the health system to “tap into the rhythms of life”, reveal insights that aren’t always obvious in clinical visits and allow “adaptive observation and serial experimentation” 

Following Professor Buchan’s presentation, Lorraine Foley, CEO of the Professional Records Standards Body discussed efforts to assess conformance in data standards and how this can help achieve benefits across the health system.  

“All the political parties at the moment are claiming technology as at least part of the solution to the challenges we face in health and care,” she said. “I think it’s more that high quality data is the solution empowered by technology; it’s the electricity that flows around the system and really allows us to super-power the system and deliver those results.” 

In order to successfully empower research, she said, there must be a single currency across regional and organisational boundaries within the NHS in the form of commonly agreed standards. Over the past year or two, Foley said, the number of software suppliers to the health system that have joined the PRSB partnership scheme has rapidly increased.  

Tim Horton, assistant director for innovation and improvement (insights and analysis) at The Health Foundation concluded the session by observing that some 30% of the world’s data volumes are generated by the health care industry.

This data should be able to be used more effectively to direct resources to where they are most needed, whether it is generating new evidence, supporting treatment decisions, designing or evaluating new treatments and processes or supporting quality improvement, he said. 

“A well functioning learning community is going to be essential for making change happen,” he said. “That requires trusting relationships and a learning culture, as well as mechanisms for convening and deliberation.

“We often find, from organisations that have sponsored a lot of innovation or improvements in healthcare over the years, that they tend to underestimate the importance of investing in mechanisms for bringing people together.”