Wandsworth uses business intelligence to improve vaccination rates

Business Intelligence is not just about financial stats and figures. In Wandsworth Teaching Primary Care Trust in south-west London, Business Intelligence tools from Microsoft have been used to get a clearer picture of how vaccination and immunisation programmes are doing – potentially saving lives. Mark Gould reports.

Laurence Gibson, a senior public health epidemiologist, makes the case for vaccination and immunisation clearly. “After running water and sanitation, childhood vaccination and immunisation programmes are the most important public health weapons,” he says. “They save lives.”

He might add that they also save the public purse a fortune by keeping people healthy and out of hospital. But if NHS strategists like Dr Gibson don’t have a clear picture of how many children are being vaccinated or whether a vaccination program is hitting or missing its targets, there are health risks.

However, the collaboration between Microsoft and the NHS in Wandsworth has produced a clearer picture of how their vaccination programs are progressing, and has in fact revealed that things are a lot better than the old way of collecting data suggested.

The old way: paper slips and data entry

Wandsworth Teaching PCT is responsible for NHS GP and community services for a diverse population of just over 269,000 people. Its £380 million budget supports 53 GPs and funds services in health centres, surgeries, people’s homes, and a new community hospital.

When PCTs were created in 2001, the government’s thinking was simple: grassroots organisations better understand the needs of the community so will use NHS cash more efficiently. To make sure that PCTs do their jobs they have high level targets and regular independent assessments.

PCTs rely on primary data from GPs and secondary data from community and district nurses to track the effectiveness of key programmes, such as child vaccinations and immunisations. In Wandsworth, the two sources were not integrated, making it hard to see whether the PCT was reaching its goals.

GPs - who do up to 95 per cent of vaccinations - rely on the postal service to send immunisation data to the PCT. Dr Gibson, explains the frustrations. “At the moment, we have a system where we get information from a paper slip,” he says.

“We have been asking for this level of data for a long time and we can really make a difference to people’s lives if we use it properly.”

“A child goes to the GP, has a vaccination, a form is filled in and gets sent to us in the post. We input the data [into a centralised data management system called Rio]. That can take some time, so we haven’t got anything like a real time picture of immunisation uptake.”

Indeed, the figures could be up to nine months out of date. With real concern over uptake of the Measles, Mumps and Rubella (MMR) vaccine in London, the pressure was on for a clearer picture that would enable the PCT to deploy its resources more effectively on areas of poor take-up.

The new way: BI

The answer lay in a deal between the NHS and Microsoft that means PCTs can access the kinds of communication and collaboration systems that boost the power and accuracy of data dramatically, without incurring extra licensing costs.

Wandsworth Teaching PCT, Microsoft and IT consultancy 21C got together to consolidate the PCT’s data sources and turn them into useful information, 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. The POC started in December last year and once the BI technologies were in place, vaccination and immunisation data was sent electronically from each GP’s local systems to the PCT’s central Rio system.

There it was integrated with information from community and district nurses, and the results were then presented as a series of scorecards and key performance indicators on the PCT’s intranet.

Early benefits

Dr Gibson is impressed: “Already we are able to strip down the existing community database to make that data easier to interrogate. For instance, I can compare low birth weight with immunisation uptake - that is something that the existing system can’t do. [BI] is easy to use and navigate. That is the real benefit.”

By June 2008, the PCT had almost 90 per cent of GP surgeries connected and was able to launch its MMR Action Group, which now has its own online workspace to discuss strategy, share resources and work out where best to deploy community nurses.

The project also found inaccuracies in the data held on the National Strategic Tracing Service, a nationwide database of NHS patients. At least 50 children registered with Wandsworth were in fact the responsibility of another PCT, and simply removing them from the Rio system resulted in vaccination uptake figures improving by five per cent.

“MMR is still a hot topic in the UK, with lots of debate among parents. But in Wandsworth, the MMR Action Group is helping parents make better-informed choices and MMR vaccinations are going up.”An additional benefit is that the IT team has a model Microsoft BI environment that it can use in other areas of its work. Meanwhile, Wandsworth’s quarterly performance figures - known as cover returns - reveal that it is closing in on targets.

MMR is still a hot topic in the UK, with lots of debate among parents. But in Wandsworth, the MMR Action Group is helping parents make better-informed choices and MMR vaccinations are going up.

And when GPs across the UK are opposing some changes to their working practices, Wandsworth Teaching PCT says its GPs are happy with the new ways of sharing data as it dramatically speeds-up payment.

Future developments

Dr Gibson looks forward to developing the BI system to give a better picture of work in all sorts of other areas such as childhood obesity, exercise, or older peoples’ issues, so that resources can be directed more efficiently.

“But we have to have numbers to back up bids for money for new targeted interventions and this is where the (BI) partnership comes in,” he says. “We have been asking for this level of data for a long time and we can really make a difference to people’s lives if we use it properly.”

About the author: Mark Gould is a former editor of the GP magazine, Pulse. He is a freelance journalist who works regularly for magazines specialising in NHS management and for national newspapers.

Want to know more? Watch our short video, or read the full case study detailing the technology used to achieve these improvements.

Come and hear more about it: Dr Gibson will be one of the speakers at Microsoft’s Annual NHS Summit at our Reading headquarters in September.