4-page Case Study - Posted 7/21/2008
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London Healthcare Trust Boosts Vaccinations Using Business Intelligence Solution
Wandsworth Primary Care Trust (PCT) is responsible for improving the health of the people living in a large area of south-west London, and has to meet a large number of government-led performance targets. Data shows that it was struggling to hit targets in child vaccination, but the team at Wandsworth PCT knew that the data wasn’t revealing the true performance picture. After meeting with Microsoft and IT consultants 21C, the organisation gave the go-ahead for a new system to speed up the data aggregation process, and support better collaborative working. Due to Microsoft® software, the figures are now more accurate, showing that the PCT increased reported levels of immunisation by 5 per cent—bettering the last reporting quarter. What’s more, new levels of collaboration are helping to increase the uptake of measles, mumps, and rubella vaccinations.
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Improved data means we can take action more quickly in areas where parents appear less likely to have their child inoculated. |
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Philip Scott, Chief Information Officer, Wandsworth Primary Care Trust |
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Situation
Wandsworth PCT is the National Health Service (NHS) body charged with making improvements to local health services among a diverse population of 269,300 people in south-west London. With a budget of £380 million (U.S.$745 million), it supports 53 general practitioners (GPs) and provides a range of services via health centres, GP surgeries, people’s homes, and Queen Mary’s Hospital in Roehampton.
When PCTs were created in 2001, the government’s thinking was simple. By operating at grassroots level, these organisations could better understand the needs of the community, and direct health spending to where it is most effective. The government imposed a number of safeguards, including targets and regular assessments by health watchdogs, to ensure PCTs fulfilled their designated roles.
It became clear that a PCT’s performance relies heavily on the way it handles primary data from GPs, and secondary data from community and district nurses. The data highlights the effectiveness of key programmes, such as child vaccinations and immunisations, and issues a warning if a programme is going off track. In the case of immunisations across Wandsworth, these two sources lacked integration, making it harder to see whether the PCT was reaching its goals, particularly around vaccinations.
GPs—who do up to 95 per cent of vaccinations—rely on the postal service to send immunisation data to the PCT on a regular basis. Administrators then input the information into a centralised data management system called Rio, which also contains data from community and district nurses. As this means that updating GP figures is very time consuming, the true picture of vaccinations across Wandsworth was never really clear, and figures could be up to nine months out of date. Philip Scott, Chief Information Officer at Wandsworth PCT, says: “Here was a situation where, according to the data, our vaccination figures could have been better than we were reporting.”
With real concern over vaccination figures in London, especially for measles, mumps, and rubella (MMR), the pressure was on for a clearer picture of vaccination uptake. The PCT saw that by aggregating immunisation data quicker, and collaborating better, it could target resources more effectively, and improve the rate of vaccinations among children. “Our plan was to create a taskforce that could tackle the problem of low MMR inoculations. But to be effective, it needed easy access to accurate data in Wandsworth,” says Scott.
Solution
There was an answer. The NHS in England, Scotland, and Wales has negotiated an Enterprise Agreement with Microsoft for low volume licensing prices on new software. It means PCTs can access the kinds of communication and collaboration solutions that boost data integration dramatically, without incurring extra licensing costs. During a series of meetings of Wandsworth PCT, Microsoft, and IT consultancy 21C—which specialises in the NHS sector—an agreement was struck on bringing primary and secondary data together using Microsoft® business intelligence (BI) technologies.
The first step was to deliver a proof of concept (POC) that could be re-used across the PCT. Everyone agreed that the child vaccination and immunisation programme was ideal for testing the concept, and work began in December 2007.
Once the BI technologies were in place, vaccination and immunisation data was sent electronically from each GP’s local systems to the central Rio system. It was integrated with information from the community and district nurses, and arranged using online analytical processing cubes for rapid analysis. The results were then presented as a series of scorecards and key performance indicators on the authority’s intranet. According to Scott, the POC was a complete success: “Suddenly, all the vaccination and immunisation data from a primary and secondary source was centralised in one easy-to-access location.”
The POC showed the huge potential of Microsoft BI technologies in delivering medical data. By June 2008, Wandsworth PCT had almost 90 per cent of GP surgeries in the area connected to the Microsoft BI infrastructure. One result was the launch of an MMR Action Group, which now has its own online workspace to discuss strategy, and share resources across the area. By learning from each other and targeting resources more effectively, they are increasing the numbers of children being immunised with MMR vaccinations at GP surgeries.
Benefits
Wandsworth PCT is increasing the number of child vaccinations across the area, because of better access to data on the number of vaccinations by GPs, and because the organisation can fine-tune its strategy and target resources more accurately. Day-to-day, staff involved in the programme are sharing vaccination information, and planning more effectively, thus making better use of their time. A key outcome has been a rise in MMR vaccinations, which has for so long been a challenge for the PCT. Finally, the IT team has a model Microsoft BI environment that it can replicate across different programmes in the future.
Immunisation Figures Improve 5 Per Cent
The PCT gains a more accurate view of the number of children that need vaccinations. Already, the technology has highlighted inaccuracies in the data held on the National Strategic Tracing Service, a nationwide database of NHS patients. This revealed that at least 50 children registered under Wandsworth PCT in fact belonged to other PCTs.
Laurence Gibson, Senior Public Health Epidemiologist for Wandsworth PCT, says: “In the last quarter, we were able to remove these 50 children from our Rio system, which resulted in our vaccination uptake figures improving by 5 per cent.” These children can then be highlighted to their correct PCT, so that they could be followed up by their respective GPs.
With vaccination data being shared more effectively, vaccination figures across Wandsworth are getting closer to meeting government targets. Each quarter, the PCT sends records of the latest immunisations, known as cover returns, to the government. These cover returns are better than they were before, simply because the organisation has a more accurate picture of the work going on in GP surgeries.
“Improved data means we can take action more quickly in areas where parents appear less likely to have their child vaccinated,” says Scott. “As soon as the team notices anything, they contact the local GPs and try to tackle the problem.”
Higher Rates of MMR Vaccination
Scott is particularly pleased with the increase in MMR vaccination across the area, in the short space of time since the new way of working was adopted. “MMR is a hot topic in the U.K. right now, with lots of debate among parents on whether to have their child inoculated,” he says. “By using the online workspace to coordinate activities, the MMR Action Group is helping parents make better-informed choices and MMR vaccinations are going up.”
Gibson adds: “Using the reporting functionality of the system, we can direct resources to areas where vaccination uptake is low, and thereby boost take up rates.”
Increased Speed of Payment for GPs
At a time when GPs across the U.K. are opposing some changes to working practices, GPs in Wandsworth are embracing the new way of sharing data. They like the fact this system means they get paid quicker. Wandsworth PCT pays them for each vaccination and uses the data to calculate a payment, but, as previously, GP figures were inputted manually, there were long delays before they got paid. The new system has reversed the situation.
Scott says: “The response from GPs has been positive. In fact, the POC has been welcomed by everyone it’s touched, and we plan to use the BI tools from Microsoft as a way to help direct health spending to where it matters most.”
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