The Healthy Wirral Population Health Programme is delivering two key solutions to reduce variations in the health of local people and improve care.
The Health Information Exchange (HIE) is a shared care record that provides access to real time patient information. Along side it, the Wirral Care Record (WCR) supports targeted intervention and prevention based on a set of wellness and condition registries. Both solutions use Cerner technology to draw data from 51 GP practices, community services, the acute hospital, and cancer centre. Further datasets will be added in time.
“The definition of population health management varies depending on who you talk to. In Wirral, we see it working on two levels: 1) enabling clinicians to identify and address gaps in the care of their patients, and 2) on a macro scale, being able to analyse data and develop intelligence to support decision making about care provision across the region.
The Wirral Care Record is live at a number of GP practices and already we’re starting to observe trends. For example our data seems to corroborate the idea that the more unmet measures there are at a practice, the more Emergency Department (ED) encounters there will be too. It follows that by providing GPs with the tools they need to meet those measures, we can reduce ED attendance. A lot of the problems faced by hospitals cannot be solved inside the hospital itself.
The aim of the WCR is to help people (by which I mean individual clinicians and managers or policy makers) understand where to focus their efforts and resources. One of the registries we’re introducing in Phase 2 is Wellness. We’re interested to see the results from this because it’s not about disease, it’s about prevention. And it takes into account so many non-health factors (housing, education and so on) to help us build an accurate picture of our population and work out where to target our collective energy to reduce variations in outcomes.”
Paul Charnley, Director of IT and Information, Wirral University Teaching Hospital
- The Wirral Local Digital Roadmap (LDR), which was produced by the Healthy Wirral partner organisations, outlines the key improvements that the region is starting to enable through the use of local shared care records, including standardising clinical processes based on best practice and using analytics to predict deterioration in patients’ conditions earlier, allowing for more timely or appropriate intervention. It also articulates the two key objectives that provide the impetus for the HIE and WCR programmes: namely to change the way health care is delivered and transform the health of the local population.
- Wirral has a reputation for the successful delivery of technology-enabled change and there is a high level of digital maturity across the region. Staff have come to view IT as a fundamental component of their working practices and have high expectations regarding its potential.
- Wirral University Teaching Hospital (WUTH) has made long term investments in its IT provision, notably its Cerner Millennium EPR, and has an excellent strategic relationship with the supplier . The decision to adopt Cerner’s HealtheIntent platform is seen as a natural extension of this relationship. The other partner organisations have also bought into the vision.
- Wirral has a significantly less complex geography and health care system than most, which may account to some extent for its success in implementing and embedding IT solutions. Nonetheless, it faces some challenges which it is keen to address. For example, life expectancy varies by over 10 years between electoral wards. Reducing this variation is one of the primary goals of the WCR.
- Federated Record Locator Model The Health Information Exchange uses a Cerner platform to connect clinical systems together.
- Data is collected on a per-request basis at the point of need and displayed in an aggregated view. It is not stored.
- The solution accesses data from GP systems via the MIG The information is real-time. All access is audited.
- Users launch HIE through their own clinical systems.
- HIE supports the delivery of individual patient care, allowing GPs and hospital clinicians to view data from across the care pathway, meaning fewer delays, improved safety and care, and a much smoother experience for the patient. Community and Cancer Centre data have recently been added to the shared record, and mental health, social care, and hospice datasets will follow, further enhancing HIE’s potential to support a more integrated model of care.
- WCR is also starting to have an impact on individual patient care and is currently most used by specialist groups, for example specialist nurses for COPD, to set up specialist clinics using the data to identify patients to target.
- A major component of the WCR population health management solution is the use of “registries”. These give clinicians a means of monitoring patient cohorts and identifying gaps in their care when certain measures are not met. In Wirral, registries are being enabled in phases. Phase 1 is live, and Phase 2 will be released later in 2018.
- Adult diabetes
- Child diabetes
- Adult asthma
- Child wheeze
- Cardiovascular disease (one for atrial fibrillation and one for heart failure)
- Substance misuse
- Wellness (split into adults and children)
- Mental health
- End of life
- Social care
- An intuitive dashboard-style display shows clinicians how each registry is performing, making it easy to see where they should focus their efforts.
- This is on the level of individual clinicians or teams working with their own sets of patients, however the solution also aggregates the data up to a population level, this time highlighting gaps in service provision across the region.
- Healthy Wirral has developed a set of objectives, with defined measures, that it aims to meet through improvements in working practices enabled by WCR. These include reducing health inequalities, improving the patient experience, supporting self care, reducing admissions, and enabling children to get the best start in life.