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CONNECTED HEALTH CITIES: ‘Learning health systems at scale for innovation and improvement’

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On March 29th, over 100 people interested in how
data can be harnessed to support, and drive health service improvement attended the UK Connected Health Cities team presentation hosted by Health Translation SA and SA Health.

The team discussed how they are linking local health data
and advanced technology to improve health services for patients across the North of England and participated in a panel discussion on the implications of data-driven innovations for health systems globally.

Published in: Health & Medicine
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CONNECTED HEALTH CITIES: ‘Learning health systems at scale for innovation and improvement’

  1. 1. Connected Health Cities Programme Prof. John Ainsworth Director john.ainsworth@connectedhealthcities.org Gary Leeming Chief Technology Officer gary.leeming@connectedhealthcities.org Dr Amanda Lamb Deputy Director & Chief Operating Officer amanda.lamb@connectedhealthcities.org Ruth Norris Head of Strategic Relations ruth.norris@connectedhealthcities.org
  2. 2. The Problem http://www.thenhsa.co.uk/app/uploads/2018/11/NHSA-REPORT-FINAL.pdf
  3. 3. “An integrated health system in which progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by-product of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and healthcare.” www.ihi.org www.p4mi.org
  4. 4. The Learning Health System Cycle Flynn et al., Learn Health Sys. 2018;2:e10054.
  5. 5. 2000s: People, data, methods From can’t to can Challenge # 1 Complexity Challenge # 3 Perception Challenge # 2 Context
  6. 6. Challenge 1: Complexity “It is not individual factors that make or break a technology implementation effort but the dynamic interaction between them” Greenhalgh T et al. J Med Intern Res 2017;19:e367
  7. 7. Solution 1: A Multi-Disciplinary Team
  8. 8. • Digital Health − Salford Lung Study – largest clinical trial in the UK involving 9,000 patients. − Health eResearch Centre (HeRC) & Farr Institute - developing new methods to generate scientific insights and healthcare innovations, bringing statisticians, software engineers and computer scientists together with clinicians. − CityVerve – Internet of Things & Smart Cities technology for improving health − ClinTouch and CF HealthHub – App supported health care • Applied Health Research − Connected Health Cities – Applying Learning Health Systems to 15m populations. − Patient Safety Centre – Using data to deliver safer care • Precision Medicine – Machine Learning − Psoriasis (PSORT) – differentiating between two forms of psoriasis to improve treatments. − Stoller Biomarker Discovery Centre – digtial phenotyping − Molecular Pathology Innovation Centre (MMPathIC) Some of our research highlights
  9. 9. Challenge 2: Context “Surprisingly few frameworks considered the organizational setting.” Greenhalgh T et al. J Med Intern Res 2017;19:e367
  10. 10. Problem: The health and social care system is facing unprecedented levels of change in policy and funding, the shifting and ageing demographics of the population served, and ever-increasing workforce pressures. Health and social care staff need to be able to plan ahead and tackle these challenges Solution: Through producing statistical models to create a predictive planning approach, this will allow healthcare organisations and GP practices to use their existing data to help to more accurately predict demand and improve service delivery design
  11. 11. Learning health system opportunity: Project leader: Judging what is true Deciding what to do Perceive the critical factors in a situation Diagnose the biggest challenges to progress Devise a coherent treatment The opportunity for a learning health system to transform care What are the current outcomes? What are the desired outcomes? What’s holding “us” back? What LHS might transform this care? Feasibility: technical change framework Where are we? Where do we want to be? What stands in the way? How will we safely get there? What data do we have? What data do we need? Data availability, quality, etc Ensure have safe havens and processes for data flows What “tech” do we have? What “tech” do we need? Cost/”perfect” system/overwhelmed by scale Build with focus on necessary tools and services, and iterate with scalable tech What methods do we have? What methods do we need? Capability, access to data Trusted Research Environment, ability to share research objects What governance do we have? What governance do we need? Differing local perspectives Enable transparency and build commitment Desirability: behavioural change framework Whose behaviour must change to deliver this transformation? Who are the stakeholders? What outcomes do they want? What is our common enemy? What common desired outcome do we share? How do people see, think and act? How must people see, think and act? What stands in the way of transforming How might we safely Limiting Beliefs Enabling Beliefs Beliefs Expand the diameter of trust Won’t Will Motivation Build a shared commitment to a common goal Can’t Can Behaviours Build capacity and capability Viability: economic change framework Where are we? Where do we want to be? What stands in the way of How might we safely Where is the waste? Where are the savings? Reducing waste and realising savings? Reduce waste and realise savings? Who pays what? Who will pay what? A compelling investment case? Obtain initial and ongoing funding?© Applied Health IOnshightsw Limited 2019 Solution 2: Building a diagnosis framework
  12. 12. Challenge 3: Perception
  13. 13. Solution 3: Perception Higher Aims Individual priorities Theory of LHS Actual learning journey Electronic Health Record Actual patient record Ground truths View from above
  14. 14. 2000s: People, data, methods From can’t to can Challenge # 1 Complexity Challenge # 3 Perception Challenge # 2 Context Challenge # 4 Citizen Trust Challenge # 5 Foundations Challenge # 6 Critical mass 2016: How to safely scale the creation and adoption of LHS. From won’t to will
  15. 15. Connected Health Cities Connected Health Cities (CHC) is a global programme harnessing the power of data for the implementation of Learning Health Systems (LHS) to deliver improvements in both system and patient outcomes through the use of innovative technologies. Backed by the UK government’s Department of Health and Social Care (DHSC) and led by the Northern Health Science Alliance, CHC has implemented multiple clinically or socially driven care pathways programmes across the health sector.
  16. 16. Challenge 4: Citizen Trust
  17. 17. Solution 4: Creating a Diameter of Trust • A new approach was conceived centred on building civic digital clusters with clear local benefits and public trust • To achieve regional critical mass and expand the “diameter of trust” Trust You
  18. 18. https://vimeo.com/284101143 Citizens’ juries
  19. 19. Elements of policy Care Pathway You are here Waste Inequality Lost opportunity Elements of policy Care Pathway From To Challenge 5: Front-line innovators require solid foundations
  20. 20. Challenge 5: Front-line innovators require solid foundations You are here Waste Inequality Lost opportunity From To
  21. 21. The sexy bit The unsexy bit Solution 5: “Nobody wants to do the unsexy bit”
  22. 22. We need all, not most
  23. 23. “Acceptance by professional staff may be the single most important determinant of whether a new technology-supported service succeeds or fails at a local level.” Greenhalgh T et al. J Med Intern Res 2017;19:e367 Challenge 6: Sustaining critical mass
  24. 24. Involved Citizens Problem owners Data managers Public Health Analysts Care Service Analysts Statisticians Data Scientists Informaticians Social Scientists Health Economists Health Service Researchers Communications Experts Chief Executive Officer Chief Medical Officer Chief Operating Officer Chief Quality Officer Chief Information Officer Chief Financial Officer Chief Research Information Officer Chief Medical Officer Physicians Nurses Hospital Staff Social Care Staff Health IT vendors Patients and families Social Worker General Practitioner (GP) Ministers Risk Management Policy Makers Guideline developers Data guardians Solution 6: Sustaining critical mass
  25. 25. Leading Large Scale Change: A Practical Guide Commitment, not compliance, sustains critical mass Compliance goals States a minimum performance standard that everyone must achieve Uses hierarchy, standard procedures and threats or sanctions to create momentum for delivery “If I don’t deliver this, I fail to meet my performance objectives” “There is no evidence in the large scale change literature that any healthcare system has ever delivered sustained transformational change through compliance, rather than commitment” Commitment goals States a collective improvement goal that everyone can aspire to Uses shared goals, values and purpose for voluntary co-ordination and control “If I don’t deliver this, I let down the group and our shared purpose”
  26. 26. 2000s: People, data, methods From can’t to can Challenge # 1 Complexity Challenge # 3 Perception Challenge # 2 Context Challenge # 4 Citizen Trust Challenge # 5 Foundations Challenge # 6 Critical mass Challenge # 8 Re-inventing the wheel Challenge # 7 Spread challenge 2016: How to safely scale the creation and adoption of LHS. From won’t to will 2019: Making it easier for front-line innovators to safely use data to save lives
  27. 27. “When initially successful interventions are spread to new settings, they may fail to achieve the same impact, or indeed any impact at all.” “The success of a complex intervention is likely to depend heavily on its context.” The Spread Challenge, The Health Foundation, September 2018 Challenge 7: The Spread Challenge
  28. 28. Solution 7: A pathway-based approach • Antimicrobial resistance and antibiotic prescribing • Healthy ageing • Alcohol misuse • COPD • Epilepsy • Childhood obesity • Autism • Stroke • Opiate dependency • Supporting community care • Unplanned emergency care • Vulnerable families
  29. 29. Pathway: Improving the management of stroke Manchester
  30. 30. Pathway: Forecasting emergency unplanned care Durham
  31. 31. Challenge 8: re-inventing the wheel Where do we start? What do we do next? Where’s the best place to invest our resources?
  32. 32. Solution 8: Blueprints are important, but not sufficient Know-how is essential “It is possible, but not accurate, to view the achievement of an LHS at any level of scale, as an exercise in construction from a blueprint. This conceptualization belongs to an earlier era. It fails to recognize that the LHS is a new and fundamentally different type of system” Friedman CP et al. Learning Health Systems 2017;1:e10020
  33. 33. Connected Health Cities: Enhance Information Flows for Better Research
  34. 34. Connecting Communities of Care and Research
  35. 35. The CHC programme: contributing to delivering policy objectives “It has been a real catalyst for change pulling Northern partners together. At a geo-political level it has been really crucial to have this investment.” Contributed to all six NHS Long Term Plan policy objectives Contributed to all six Department of Health and Social Care priorities 2018-2019
  36. 36. “I really enjoy where I am and my job, it’s a different world compared to being in a lab and you can’t see your significant finding making it to the clinical face for another 20 years whereas here, it will have an impact and I will see that impact whilst I am still on the project, so yeah, it’s exciting.”
  37. 37. 1. Working with complexity Multi-disciplinary team 3. Perceiving reality Reveal ground truths 2. Understanding context Diagnose before treating 4. Addressing Citizen Trust #DataSavesLives & PPIE 5. Building quality foundations Pathway by pathway 6. Sustaining critical mass Listen, learn then lead 8. Avoiding re-inventing the wheel Blueprints, resources & know-how 7. Enabling spread Making LHS tractable DataSavesLives: the community for LHS Design, Safety and Learning We can’t do it alone. We need your help. Join the movement at www.connectedhealthcities.org 9. Curating global learning Community of practice 2000s: People, data, methods. From can’t to can 2016: How to safely scale the creation and adoption of LHS. From won’t to will 2019: Making it easier for front-line innovators to safely use data to save lives Working Together for Data to Save Lives From waste, inequality and missed opportunities to better care, cheaper care and better outcomes
  38. 38. Join the #DataSavesLives movement to make creating LHS easier Join the movement at www.connectedhealthcities.org via the contact us page #DataSavesLives @CHCNorth

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