ARC WM Blog Content

The French mathematician Pascal observed that humans are paradoxical. He was right. As lead for the Acute Care Interfaces Theme I have to take two completely opposing positions on the value and use of routine data. This new theme in ARC West Midlands is linked to two distinct health databases that illustrate both the power and weakness of our quest for collating that which is already collected.

I am the Chief Data Officer of a newly funded Digital Innovation Hub in Acute Care – these Hubs showcase how industry, academics and policy makers can use existing datasets for innovation, product development and discovery. Our Hub will be a forager of every possible piece of healthcare data that is a by-product of routinely provided acute care across community and hospital settings in a population of five million people.

Population based data across all providers are compelling in their potential. We can map journeys through the labyrinth of multiple acute providers to understand how and why people access care in a crisis. We can begin to understand how to better meet the acute care needs of a large multi-ethnic and multi-morbid population with significant deprivation. Who is disadvantaged with current care delivery? How do presenting acute syndromes change as we age and become more complicated? Which diagnostic tests and treatments could we undertake outside hospital, reducing the need to leave our homes when we are unwell? Where do industry, research funders and policy makers need to focus attention to innovate and stimulate change in the delivery of acute care so that we can meet relentless increases in demand?

At the same time, I know that fundamentally important elements of acute care are completely missing from routine data. I lead a national hospital audit for the Society for Acute Medicine (SAMBA), which is designed to measure precisely the things we know are missing from all other sources of data. This is the trouble. In order to find what matters in acute medical care, we know that we have to get into the middle of care delivery in real time and observe what is going on, and there is nothing routine about that. If I want to know the tortuous path through different care locations that a patient experiences within a hospital, then the direct clinical care team is the only reliable source.

There are more questions where routine health data collection mechanisms can’t help. Do people live in a care home or their own home before they are catapulted from their bed into the emergency department? Do patients have an advanced care plan to guide the clinicians who are meeting them for the first time? When did an acute medical consultant review a treatment plan? What are the actual opening hours of an ambulatory care unit or an acute frailty unit? How can we determine the gap between work as imagined and work as done in acute care settings?

There are blind-spots of significant size and importance in data that are collected as patients pass through their healthcare provider. We have uncovered those blind-spots in the SAMBA audit because patient and clinician experiences of acute care delivery have told us what is missing and what we need to collect to understand how acute care functions. Observations that put us ‘in the moment’ of acute care delivery allow us to see what we are doing in acute medicine against an organisational background that is different from hospital to hospital.

To disprove Pascal and solve the paradox of believing and denying the value of routine data, our Acute Care Interfaces Theme will temper the reliance on complex analyses of what we have collated routinely with the development of new data collection systems that can re-create the delivery of acute medical care. Patients, as judges of their healthcare, should specify the data collection systems that are meaningful for their experiences of acute illness and its treatment. Then we will see clearly as healthcare observers and have true digital innovation.

Dan Lasserson, ARC WM Acute Care Interfaces Theme Lead