How geography can make healthcare more strategic, more patient-focused and more cost-effective An Esri UK White Paper

Transcription

1 How geography can make healthcare more strategic, more patient-focused and more cost-effective An Esri UK White Paper

2 The power of the map In 1854, a cholera epidemic gripped London s Soho. But finding the source of the outbreak proved problematic. With chemical tests of the local water supply inconclusive, leading epidemiologist John Snow decided on a pioneering approach: he used spot mapping to plot the locations of cholera cases in the local area. Based on the patterns that formed on the map, Snow tracked down the likely source of the local outbreak to a contaminated hand water pump on Soho s Broad Street. Unwittingly, Snow had become the very first user of the world s very first Geographic Information System (GIS) for healthcare. The untapped potential Over a century and a half later, the power of geography to reveal hitherto unknown healthcare patterns, trends and relationships still remains largely untapped. And yet geography is even more relevant to healthcare today than it was 150 years ago. Today, geography can reveal how close people are to the healthcare facilities they need. It can identify demographic changes and shape public health strategies from a national level, to supporting local decision making with street-level information. It can highlight geographical variations in health, and identify over- or under-spending on prescription drugs, equipment, estates and more. All because of the map, and its powerful ability to draw together and make sense of seemingly unrelated information. Discover the possibilities In this paper, you can learn more about Geographic Information Systems technology. And through GIS maps, real case studies and scenarios, you can discover some of the key ways in which GIS can help to make healthcare more strategic, more patient-focused and more cost-effective for good. Figure 1. John Snow s spot map of cholera outbreaks in Soho, London,

3 What is GIS? A Geographic Information System is intelligent software used to display data geographically. By layering different datasets onto a map, a GIS provides a powerful way to organise, analyse and report on that data, highlighting patterns, trends and relationships far more quickly and clearly than spreadsheets and tables ever could. This generates insight that helps organisations to optimise processes, reduce costs and boost their effectiveness. GIS works because the vast majority of data contains a location element. By making that location the common denominator, GIS enables seemingly unrelated data to be brought together to offer new insight and intelligence. Within healthcare, GIS offers an alternative and complementary approach to using patient identifiable data, as it enables information to be brought together without compromising confidentiality. Hundreds of thousands of datasets can use the map as a context patient demographics, disease prevalence, prescription costs and medical facilities are just a few examples. By putting location at the heart of it all, there is real potential to drive smarter, more proactive, more cost-effective healthcare services at a local and national level. On the following pages, we discuss some key examples. Figure 2. Hundreds of thousands of different datasets can use the map as a context 3

4 The power of GIS in healthcare: for patients and the public Helping patients make more informed healthcare choices For any patient trying to decide where best to receive medical treatment, there is a wealth of comparative information available online. Collected by measuring patient experiences, clinical outcomes and patient safety, this information covers a range of factors that may affect someone s choice of medical provider from mortality, to ease of access. Much of this data is currently in tables and lists, making it hard for patients and GPs to make informed decisions about treatment provider and treatment options. Collective analysis Through GIS technology, anonymous data about patient experiences, clinical outcomes and patient safety can be plotted onto a map, to identify patterns in care services. By putting this map-based data online, patients and their advisers can see at a glance which care options best meet their specific needs. Keeping the taxpayer informed In the same way, making information about a healthcare service s performance available online can enhance citizen engagement and boost transparency. The public can use a GIS map to see a range of performance indicators for their local GP, hospital or care provider. It s also possible to use the map to show exactly how their tax is being spent on health services. Driving a more strategic approach to public health There is a great deal of evidence to suggest that a person s health is strongly affected by environmental factors. Those who live in more deprived areas, for instance, often have less access to green space, and more problems with air pollution. But many environmental health factors are not so easy to identify. Depicting correlation Through GIS, it becomes far easier to correlate environmental causes with health effects over time. By bringing together local environment information with data about local residents and their health conditions, it s possible to build a health map. Over time, the patterns and hotspots highlighted on this map can help to forge clearer links between environmental factors and the general health trends within a region. Organisations such as the Health Protection Agency (part of Public Health England as of April 2013) already recognise how valuable this can be in driving better, more tailored strategies for public health at a regional or local level. Figure 3. Examples of health maps designed to demonstrate the spatial variability of one or more variables (e.g. population, incidence of disease or deprivation measures). 4

5 Case study: West Midlands Cancer Intelligence Unit West Midlands Cancer Intelligence Unit is using GIS from Esri UK to gather and analyse a wealth of information about cancer among the local population, in order to better understand the disease and develop better preventative and remedial care. GIS enables the Unit to: provide a vital link between cancer data and environmental and socio-economic factors. relate cancer data to geography, addressing questions of proximity and distance. provide cancer information and statistics to other relevant organisations, and address unusual requests for information. find new ways to visualise cancer information. Figure 4. A health map designed to demonstrate the spatial variability of one or more variables (e.g. population, incidence of disease or deprivation measures). For more information about how the West Midlands Cancer Intelligence Unit uses GIS, visit: Case study: Public Health Observatories The Public Health Observatories across England (part of Public Health England as of April 2013), as well as those in Wales, Scotland, Northern Ireland and Republic of Ireland, turn information about people s health and healthcare into valuable intelligence for practitioners, policy makers and the public. In order to do this, GIS from Esri UK plays a key role, offering effective insight into data for the delivery of better healthcare services and greater transparency with the public. Figure 5. An example of how a Public Health Authority uses GIS for deprivation analysis in order to better target resources. 5

6 The power of GIS: in primary care Helping GPs identify and prevent chronic disease earlier General practitioners are encouraged to diagnose chronic disease as early as possible, to improve health and reduce the future burden on the NHS. In order to diagnose early, GPs must learn as much as possible about how likely each of their patients is to develop a chronic disease. Currently, most risk stratification tools are based principally on medical records. But the likelihood of chronic disease stems from a far more complex set of challenges. Diet and exercise; smoking and alcohol consumption; sexual behaviour; quality of housing and economic stability; whether or not an individual has a long-term partner all of these factors and more can affect someone s probability of developing long-term illness. Yet medical records only show part of each patient s story. And because they re mainly text-based, they also make that story harder to interpret in the first place. GIS, on the other hand, has the potential to greatly enhance risk stratification by bringing together many different factors beyond medical records, in order to paint a much richer and clearer picture. More accurate risk profiling National retailers are already using GIS to put customers demographic and purchase history data onto the map, in order to target specific offers to individuals. In housing insurance, GIS is already used to identify a specific building s risk profile, down to a radius of just a few square metres. When it comes to healthcare, similar techniques can be used to pull these disparate datasets together so they can be plotted onto the map. Using this data, GPs could develop more accurate forecasts of patients facing particular risks. In turn, this would allow for earlier interventions and preventative treatment. What s more, by coupling it with patient medical records, GPs could gain even greater insight. Esri UK: gaining insight into effective prescriptions management Robust prescription practices are essential for good healthcare. And managing prescriptions activity effectively is a key part of a GP s work. 3 Cost per Item Cost per Item Esri UK is in the process of integrating the primary care dataset into our GIS, to create a tool that provides valuable insight into prescription practices. We re studying the data in a number of ways. This includes trying to identify overprescribing, the cost of patented versus generic drugs, and a range of other factors that can have an impact upon effective prescriptions management. Figure 6. This map shows variation in the cost per item prescribed in primary care 6

7 The power of GIS: for commissioners Supporting better commissioning decisions, locally and nationally Commissioning is a complex set of processes. Commissioners must understand the developing healthcare needs of a population, make appropriate interventions, and contract effective, efficient services. They also have to judge the impact of providers and specific health interventions over time, decommission services that are not effective, and then communicate their decisions to the public. All of this requires ongoing assessment of an enormous variety of detailed data. Patient demographics; local health risk factors; the health impact of housing, income and relationship status; the accessibility of local care services. Whether at a local or national level, commissioners need insight into all of these areas and more, understanding the whole dynamic of the health economy in order to make the best commissioning decisions. But getting a holistic view can be extremely challenging. Information is often buried within and distributed across a number of public health and local government organisations. More transparent commissioning A Geographic Information System can be used to bring together appropriate information across multiple departments and organisations. Data from all of these departments can be overlaid onto the map, to create a single, centralised view that can help commissioners make more strategic healthcare decisions. Importantly, this data can be viewed in all manner of ways. Patterns, trends and relationships can be identified at a micro level looking at just a few streets all the way up to a macro level, and a national scale. Through modelling tools, GIS can also be used to map past results, current status and future predictions, to help commissioners accurately forecast the impact of potential decisions, and illustrate how changes take effect over time. What s more, this map-based decision-making process is highly transparent, and easy to share with the public in the form of web maps. In this way, it becomes far quicker and easier for commissioners to justify their decisions, and gain public support. Figure 7. Just one small example of how GIS can support commissioning. 7

8 The power of GIS: for resource management Making the best use of staff time For the thousands of community-based care staff who work in the NHS, it can be extremely difficult to optimise productivity. Some patients, for instance, may not be at home when their carer calls, requiring a second visit later. Some may need or want further care than was predicted, meaning a visit lasts longer than the allotted time. Others may simply be farther away, requiring a long car journey which in itself can be hampered by roadworks, congestion and other unforeseen travel issues. Traditional rostering can only tackle these issues to a limited extent. Given the amount of unpredictability in their work, community care workers ideally need the support of a far more flexible, intelligent system to help them optimise their use of time. Dynamic rostering Using GIS, it s possible to plan the optimum roster based on the location of patients and carers. And it s also possible to dynamically alter this roster if the need arises. Using smartphones linked to the GIS, care staff can keep their care manager informed of their location at all times. They can also send updates in the event of traffic, or if patients are unavailable. Through this real-time information, the care manager is always empowered to decide the most efficient and clinically appropriate course of action depending on the skills of the carers out in the community that day, their location, the clinical requirements of each patient and the urgency of their needs. This can enable carers to spend more time with patients and less time travelling, for a better, more efficient service overall. Optimising use of estates and assets Within many care estates across the UK, the building design is outdated, and often configured for now obsolete methods of care. As a result, staff and patients can spend excessive time travelling from place to place, wasting valuable care time and affecting the patient experience. Inefficient design such as this is also costly, in a number of ways. The 2009 McKinsey report commissioned by the Department of Health, for instance, suggested that spare NHS land and buildings could be sold to recoup 8.3 billion. Moreover, within a typical hospital there exists a vast equipment base, estimated to be worth between million simply to service the complex infrastructure. And yet much of it lies unused, broken as a result of a lack of servicing, or simply waiting as spares, to prevent the higher cost of theatre downtime. Through GIS, however, both of these issues can be tackled head on through a process called Geodesign. Mapping the flow of people and equipment Geodesign is the process of using GIS tools to forecast the impact of a range of spatially-related factors upon a design activity. Within the context of healthcare estates and assets, Geodesign makes it possible to predict how people and equipment will flow under a given set of circumstances and in a given location, with the aim of optimising that flow. 8

9 For example, information about staff and patient journeys within an acute trust or local community can be overlaid onto an appropriate map. Management teams can use this to visualise and optimise the flow of people minimising patient and staff walking time, while maximising the amount of time that staff can spend delivering care. A similar process can be used to make the best use of medical assets. By tracking how equipment moves and where it is used, providers can buy equipment and consumables informed by real usage patterns, and also decide where best to store them for maximum accessibility. And when new healthcare facilities are being constructed, the full potential of Geodesign can be realised with GIS used for smarter design, asset management and flow of people from the ground up. Figure 8. The circular diagram on the left shows peak admissions at Leeds General Infirmary. Mapping admission data like this by day of week (rings) and hour of the day (slices), as well as location, could help optimise staffing patterns for individual hospitals, optimising both costs and provision. 9

10 Case study: SHAPE (Strategic Health Asset Planning and Evaluation) GIS from Esri UK underpins the pioneering NHS SHAPE programme. SHAPE is an innovative, flexible online GIS application. It draws together a variety of datasets and makes them available for analysis, insight and strategic planning activities across a breadth of health activities from public health to asset management. It s available free of charge to NHS and Local Authority staff with a role in Public Health or Social Care. SHAPE is designed to: Link national datasets for clinical analysis, public health, primary care and demographic data with estates performance and facilities location Enable interactive investigations by SHAs, PCTs, NHS Trusts, GP practices, commissioning consortia and local authorities Support key policy initiatives such as QIPP, JSNA and Transforming Community Services For more information about SHAPE, visit Prevalence Mortality Expenditure Figure 9. These maps, prepared using SHAPE, illustrate significant variation in total cancer prevalence, mortality and expenditure. Interestingly, there does not seem to be a neat correlation between these three factors. 10

11 Seeing the bigger picture If the healthcare system embraces GIS in the same ways as other areas of government, there is potential for hugely positive, transformational change. Instead of relying on siloed databases of lists and spreadsheets, organisations must be prepared to share appropriate, anonymised data. GIS can extract meaning and value from all sorts of disjointed information, so it doesn t matter about the format or how complete the data is. As we have seen in this document, many healthcare organisations are already making excellent progress in sharing their data and using GIS to gain new insight and transform service delivery. The whole healthcare sector can learn from these examples, as well as from organisations across local and central government, where geography is heavily used to inform policy making, improve the wellbeing of local residents, make council services more accessible and to help reduce operational costs. Indeed, data sharing is being strongly encouraged across the public sector by the open government agenda, whilst being advocated by the Department of Health. By adopting this more open, collaborative approach to data, and adding the power of GIS technology, organisations throughout the healthcare sector can discover powerful new ways to deliver more proactive, efficient and cost-effective healthcare services. 11

12 About Esri UK Esri UK is part of Esri: the world s leading provider of Geographic Information Systems (GIS). We are an essential partner to the UK public sector. Trusted by healthcare organisations Within healthcare, GIS from Esri UK helps to put health and health service information into a geographical context for improved commissioning and better use of resources. We already work with a number of high profile organisations including the Health Protection Agency, the NHS Counter Fraud Service and the Blood Transfusion Service to help them use their geographic information for greater innovation, cost-effectiveness and efficiency. As the NHS reforms are implemented, Esri UK GIS can support decentralised commissioning and local planning. We can help new provider organisations bring together existing data, and make the right decisions faster. Trusted by government For decades, organisations across local and central government have trusted Esri UK GIS to help them boost operational efficiency and cost-effectiveness. Our solutions are deployed in central government departments and agencies UK-wide, from Defra and the Forestry Commission, to the Crown Estate and the Ministry of Defence. They are also used by the majority of local authorities to help them join up, collaborate and deliver smarter, more efficient services. Esri UK is the leading supplier of GIS in the local government market, working with a range of authorities from county councils in Hampshire, Gloucestershire and Durham, to city councils in Glasgow, Leeds and Westminster. Find out more To find out more about the innovative solutions, technology and services that we provide, contact health@esriuk.com Esri UK Millennium House 65 Walton Street Aylesbury Buckinghamshire HP21 7QG T F E info@esriuk.com ESRI (UK) Limited Registered in England and Wales No VAT No Registered Address: Millennium House, 65 Walton Street, Aylesbury, Bucks HP21 7QG. All rights reserved. The Esri globe and Esri products, services and trademarks mentioned are trademarks of Environmental Systems Research Institute, Inc. Other companies and products mentioned herein are the property of their respective trademark owners.