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Putting Connected Health Cities in Context

The approach taken by CHC enabled local ownership of change, adoption and impact coupled to a facilitatory central core that catalysed knowledge spread, scale-up and the amplification of quality foundations to support the learning health system and its critical mass of experts.

At the heart of CHC is what’s called a learning health system (LHS). An LHS is defined as “science, informatics, incentives, and culture aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience” (5).

Based on the footprint of the four northern Academic Health Science Networks (AHSNs), regional CHC LHS projects were focussed on the need of the local system. Each project deeply understood the context, complexity and perspectives of those delivering frontline care and their requirements

for change.

However, it was the size of population in which CHC operated that was critical for successful delivery. Change would impact service users, patients and local citizens. To truly involve the public in these changes in a meaningful manner, a ‘diameter of trust’ with an upper boundary of 5m people was set. This enabled changes and improvements to impact citizens, their families and their local communities: the reciprocity requirement that so clearly came out of our citizens’ jury work.

Historically, a huge barrier to innovation in health has been the time between data becoming available and it being used in an actionable way; this is termed data-action latency (DAL). DAL is a measure of the maturity of a data system: the bigger the DAL the less mature the system.

CHC introduced DAL as a key metric of the LHS to monitor continuous data driven improvement. Significant reductions in DAL were observed; with one front-line innovator reporting a reduction down from 10 years to 18 months. Reductions were achieved by bringing together the right people with the right methods and right data; to deliver the best care for the right patients at the right time.

Embedding systematic approaches to system wide change required multiple supporting enrichment programmes. Each regional had specific workstreams focussed on public involvement, workforce  development, robust and secure data analytics platforms, industry engagement, information governance, and consent or preference setting. Combined, this approach provided the framework to build reproducible and scalable solutions that made LHS tractable. Ultimately, the LHS made it easier for front-line innovators to safely use data to save lives.

The Diameter of Trust

Developing regional centres for sustainable impact and scalability to reinforce trustworthy use of data across a population of 3-5 million citizens:

  • Large enough for economy of scale and small enough for a conversation with the citizens about data sharing in a way that meets local needs and concerns.

  • Designed to manage data quality, and share expertise and data infrastructure for research and innovation.

  • Projects deliver reciprocity to the population providing the data, improving the health of their communities.

Building System Change

Today in the North of England, mobilised teams of researchers, clinicians and partners are able to accelerate impact to patients and citizens through data driven improvement in a matter of months, where it would have previously taken years.

Programme deliverables achieved

  • Establishment of data sharing strategy and agreements for each region

  • Establishment and delivery of governance arrangements for the sharing and usage of data for each region

  • Workforce arrangements optimised and continuing professional development requirements identified

  • Creation of Arks as analytical platforms

  • Pathway analysis, variation assessment and improvements identification

  • Data Frameworks and integration with R&D partners

  • Production of suitable business models for scaling and sustainable for delivery in the NHS

Demand generated using replicable approach

  • Funded for 8 pathways and delivered 16 diverse pathways

  • 100% coverage of data sharing agreements in local areas

  • Up-skilled local workforce, built critical mass of experts and transformed working from silos to team

  • Four locally owned data Arks and six trusted research environments created

  • Identified replicable approaches: what works, and where and the know-how to scale

  • Connecting UK and global health systems & researchers

  • Know-how commercialisation: immediate interest in “blueprint” & consultancy

  • Future pathway project commercialisation potential for the benefit of NHS

  • Export demand: interest from overseas health systems in 9 countries

Ready to scale for innovation and improvement

  • Enabled front-line innovators to improve care, reduce waste and unlock learning

  • Shaped learning health systems to deliver policy objectives and influence policy

  • Codified the knowledge and apply the know how to scale what works in different contexts

  • Created online library and community for open sharing of applied resources and best practice

  • Focussed on collaborative approach with existing projects as well as innovative new initiatives to achieve short-term gains with long-term impact in UK

Meeting National Priorities

Today in the North of England, mobilised teams of researchers, clinicians and partners are able to accelerate impact to patients and citizens through data driven improvement in a matter of months, where it would have previously taken years.

DHSC priority: Keep people healthy and support economic productivity and sustainable public services.

Added value: Regional and care pathways are beginning to address health inequalities across the health and care system in the North of England to reduce unjustified variations in health outcomes. The creation of new algorithms and analytical platforms has the potential to be applied throughout the UK to assist DHSC in improving the health of the population.

DHSC priority: Transform primary, community and social care to keep people living more independent, healthier lives for longer in their community.

Added value:  The CHC programme has established the foundational infrastructure across the North of England to improve health and care through better use of digital, data and technology. The knowledge and skills of CHC staff and partnerships could be leveraged as part of the wider DHSC digital revolution.

DHSC priority: Support the NHS to deliver high quality, safe and sustainable hospital care and secure the right workforce.

Added value: The collaborative and multidisciplinary approach of the CHC programme has allowed innovation in the creation and piloting of prediction models that can highlight resource and staffing gaps during period of high demand, which could be applied across the U.K. Some care pathways are testing a more targeted approach to solving health inequalities, enabling clinicians to learn from and evolve patient pathways in a shorter period of time.

DHSC priority: Support research and innovation to maximise health and economic productivity.

Added value: CHC programme funding has contributed to the building of technology and health informatics infrastructure in NHS organisations across the North of England, allowing the flow of data to identify key health issues within local populations. Each region has developed its own infrastructure for clinical research and medical innovation through the creation of Arks and employment of skilled staff.

DHSC priority: Ensure accountability of the health and care system to Parliament and the taxpayer; and create an efficient and effective DHSC.

Added value: There are a number of areas where CHC programme outputs could be shared and applied across the U.K. For example, the creation of regional governance structures to facilitate the use of routinely collected patient data in research, data sharing agreements and creation of patient and public involvement groups.

DHSC priority: Create value (reduced costs and growing income) by promoting better awareness and adoption of good commercial practice across the DHSC and our arm’s length bodies.

Added value: The CHC programme has created regional partnerships across the North of England between NHS Trusts, HEIs and industry with governance structures and commercialisation protocols in place that protect patient data confidentiality that could be utilised by the DHSC in driving innovation and digital change with NHS suppliers both nationally and internationally.

Connected Health Cities International

CHC has developed a pipeline of international routes for scale-up, sustainability and knowledge transfer.

This was supported by regular and repeated engagement with academic institutions, health organisations, government bodies and industry across the US, Canada, Australia, Singapore, China, Japan and Europe. Engagement was holistic: presenting the CHC programme at international conferences and symposia (e.g. Medical Informatics Europe, Hi.Tec Singapore 2019, BioJapan 2018), development of longer-term collaborations and replication of the methodology and projects, and meetings with senior leaders in governments and health authorities.

A wide range of health system leaders have explored collaboration including: the Singapore Ministry of Health; New South Wales Ministry of Health; South Australia Health and Medical Research Institute; Beijing University (PKU) National Institute for Health Data Science; China National Health Development Research Centre; Institute for Global Health Policy Research, and World Economic Forum (WEF) Centre for the Fourth Industrial Revolution, Japan.

As a result of this successful international relations programme, a community of practice has been agreed to promote sharing and access to a suite of online tools and software.


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