Why collect clinical data? It’s an important question – but one which few people ask.
There is little point in collecting data unless you can do something practical with it, and in CCG terms that means using it to give better or more cost-effective care. Clearly, CCGs will need data to monitor their commissioning and contracting activities together with information that by statute they will be required to gather.
Improving quality of decisions
Nevertheless, by far the most practical and immediate way for CCGs to save money is by improving the quality of decisions that clinicians make when in direct contact with the patient.
This is where the type of CCG you are in makes such a difference. As I described last month, CCGs can be divided into two classes. In Class 1 the clinicians are in charge; in Class 2 they aren’t. Doctors in a Class 2 CCG risk being overwhelmed with requests for data which have little clinical relevance, whilst simultaneously not receiving the information they actually need for their day-to-day work.
Class 1 CCGs will be different. Here the emphasis will be on providing information that matters, either because it helps refine clinical pathways, or – much more importantly – through making clinicians more acutely aware of the needs of the patient in front of them.
It’s the immediacy of information (or rather, the lack of it) that is the big problem. The NHS has huge amounts of data relating to past activity – but for clinicians that’s not good enough. It may be interesting that the practice’s referrals to dermatology went up by 2.73% during Oct-Dec 2010, but this information doesn’t help the doctor to treat the patient currently consulting them.
Less data collection?
Surprisingly, Class 1 CCGs may actually be able to reduce the amount of data they collect. The bottom line will be simple: does this information help the clinician treat the patient more effectively? And can the CCG get this information to the clinician’s desktop in real time – at the point where they are making the decision? Nothing else matters. Just appreciating that this is a prime function of the CCG’s clinical informatics will focus its data collection, making it vastly more cost-effective, and much less intrusive.
What is the minimum dataset for clinicians? The key information is about recent unscheduled care: attendance at A&E departments and/or emergency admissions, especially where these relate to frequent attenders and those with known chronic disease.
The more quickly this information can get to the clinician, the more quickly will that clinician be able to recognise that the patient’s condition is going out of control. In turn this provides the opportunity to change the medication, call on the services of the community matron, or make a formal referral to outpatients.
Secondary uses service data
Some of this information, particularly about patients with chronic illness, comes through the analysis of SUS (secondary uses service) data. Our CCG uses MedeAnalytics, which provides helpful analysis of secondary care attendance: your PCT/CCG may have selected a different system.
Nevertheless, all these systems have the same big failing caused by the same common denominator: a lag of at least two months between the patient attending hospital and the presentation of the SUS invoice – which can hardly be said to provide clinically up-to-date information. Still, it’s a start, and it’s most useful in those with chronic illness.
But increasingly hospitals are being encouraged to produce data about A&E attendances which can be processed within a day: this can be vital in helping clinicians direct their care most effectively. In Luton, each practice is able to see which of its patients attended casualty in the last 24 hours: the practices can then target their resources appropriately.
Immediate, relevant information, straight onto the clinician’s desk: this is the way for CCGs to save money and give better clinical care. The best CCGs won’t be counting everything; increasingly they will collect only data which focuses clinicians’ attention onto those patients for whom change is clinically beneficial.
- Dr John Lockley is a GP in Ampthill, Bedfordshire; clinical lead for informatics at Bedfordshire CCG; and clinical co-ordinator of the Midlands and East MedeAnalytics project.