How data enables transitioning to the digital health platforms of the future

Data held independently to applications is the bedrock on which future healthcare systems will be built – and we’re already starting in Wales. Dylan Roberts, Prif Swyddog Digidol a Gwybodaeth, Chief Digital and Information Officer at Betsi Cadwaladr University Health Board explains. 

NHS Wales has five key aims of healthcare which are, to improve outcomes for patients, reduce costs, improve experience (for everyone), enable equity of access and reduce staff burnout. Very similar to those aims of NHS England and NHS Scotland. However, we are taking an alternative approach in terms of systems.

We believe that in order to solve the problems of today, we must also to consider the requirements of tomorrow. As the population grows and health care provision becomes more complex, no matter how we adapt our hospitals, they will never be efficient enough to cope with the current levels of rising demand. We need to turn some aspects of healthcare on its head. By encouraging more patient involvement with their own health and supporting self-care we can enable faster interventions to help prevent conditions getting worse by treating them earlier. In short, we want to do everything we can to keep people out of hospitals.

Longitudinal patient records

Data is the key to all of this. Patient data that is accessible for all the different types of healthcare provision, from acute to GPs, community, mental health, and independent therapists and voluntary organisations. For example, if someone has diabetes, there are wearable devices now available that can monitor blood levels and give a boost of insulin when required. If all of this data goes back to the patient’s record, and can be seen by any other health professional, it means that a fuller picture of that patient’s health and treatments can be seen. With a more complete picture of the patient, built up of data from different sources, better care and medical decisions can be made.

When patient data is held in one place it opens up the opportunity for a wider range of vendors and suppliers to provide specialist capabilities, including consumer-based services such as health clubs and community pharmacies. It also means the data can be more securely protected. In addition, when centralised patient data is combined with demographic, social, environmental and other data to produce complete longitudinal records, the information can provide insights into population health across regions which can inform future planning and provision of healthcare services and public health interventions. This sounds easy to do, but in practice its hard to achieve because, at the moment, data is in siloed and locked in systems that don’t talk to each other very well.

A modern healthcare system

So, what does the healthcare system of the future look like?

In much the same way as music consumption has gone from vinyl records which are a beautiful recording, but you couldn’t change them in anyway, to the audio tape, where you could record your own choice of music (from the radio for those old enough to remember the heady days of the Top 40 countdown on Radio 1 on Sunday evenings) which you could change, but you had to go through the whole process again. To the current times where we have all have playlists on our phones or in the cloud, with endless composable permutations depending on our mood. So electronic patient record systems have and are evolving to be personalised around needs.

Currently many health trusts are using monolithic, one-size-fits-all, electronic patient records (EPR) systems, which are probably akin to the vinyl record. Some trusts have taken a more best-of-breed approach, stitching together disparate systems to meet their particularly requirements. However, any change with any of the individual systems can mean renewing/reworking the integrations to keep everything working together in harmony – much like the mix tapes of the past.

Healthcare in the cloud – an open platform approach

In NHS Wales we are looking to fast forward to the health industry equivalent of the playlist in the cloud. These composable architectures are already in development by service providers such as Amazon, Google and Microsoft.

We are taking an open platform approach, where data, applications and user interfaces are all separate. This separation and the National Data Resource in Wales means that the data repository and application interfaces that can be made available to third party vendors to develop new capabilities. Utilising a combined patient record, in this way, we can standardise and simplify core activities such as booking appointments and taking diagnostics, while building a platform that supports increased specialisation.

Rather than trying to bend monolithic systems to fit many eventualities, specialist providers will develop expert systems that handle just one area of specialisation extremely well. It will take patient data from the central repository and repopulate with up-to-date information on treatments, interventions, medicines and the patient’s responses.

Personalisation for patients, and clinicians

Future healthcare systems will be personalised around the individual. Patients with complex requirements will have their own suite of tools and apps that tie into their circle of care, with all data going back to the central record. Similarly, clinicians will be able to personalise the way that they work too. Depending on their role, they will be able to configure items in their personal portal. In addition, they will be able to personalise the portal with the specialisation that they are working on, all of which can be accessed via digital identity with single sign-on via a badge tap or virtual smartcard (for example).

When an open platform approach is taken that keeps data, applications and interfaces separate, patients, clinicians, hospitals, GPs, community and social care, therapists, and voluntary services in the third sector will all be able to access the unique combination of services they need. This is the vision of future healthcare systems in Wales, and the journey has already started.