Population Health and HIE in the UK: Transatlantic Opportunities and Perspectives

Oct. 30, 2013
In September, community leaders in Leeds, England announced a broad collaboration around population health and health information exchange in England’s third-largest city and one of the major metropolises in the United Kingdom. Working with an U.S.-based HIE and accountable care solutions vendor, community and health leaders in Leeds are looking to provide international-level leadership on community-health population health management.

In September, a transatlantic collaboration was announced that could possibly stimulate progress in care management both in the United Kingdom (UK) and the United States. The collaboration involves, on the one hand, Leeds and Partners, an organization responsible for attracting investment to the British city of Leeds, along with key local health and social care services providers, including physicians and hospitals in that city. On the other side of the collaboration is Alere Inc., a Waltham, Mass.-based provider of healthcare solutions, including near-patient diagnosis, monitoring, and health IT solutions, and including in particular its division Alere Accountable Care Solutions (formerly Wellogic).

As a September 11 press release noted, “The collaboration has been set up to advance the establishment of a health information exchange [HIE] in the city to support existing work on the delivery of a single election health record [EHR] that all NHS [National Health Service] services could use, tightly integrated with social care services. This would enable a patient’s entire care team to access comprehensive information and collaborate on care, while also allowing patients to engage with their care teams and take a more active role in their own health and wellness.”

What’s more, the press release continued, “As part of the collaborative framework, patient data will remain securely held by the NHS and will not be shared by the health and social care partners in Leeds. The partners expect to demonstrate how sophisticated technologies can create the clinical excellence and financial outcomes needed to transform the region’s and country’s health system.”

The release quoted Tim Kelsey, national director for patients and information at NHS England, as saying, “High quality information at the point of care is essential for the delivery of safe, high-quality, value-for-money care. NHS England is committed to ensuring this becomes embedded into the fabric of the NHS. The program in Leeds will help demonstrate how such an approach can help healthy people across the country stay well, while aiding people who suffer from chronic conditions better manage their care and ultimately lead more productive, healthier and happier lives,” he added.

Shortly after the announcement, Tim Straughan, director of health and innovation at Leeds and Partners, spoke with HCI Editor-in-Chief Mark Hagland about the public/private and transcontinental population health initiative. Below are excerpts from that interview.

At Leeds and Partners, what have been your overall strategic goals in this broad initiative?

Starting with the really big picture, I’ll mention that Leeds is a big city just across the Pennines from Manchester, one of the biggest cities in the UK, with a metro area population of 3-4 million and a city population of 800,000. And the role of Leeds and Partners is that we’re the investment arm of the local council, the city government. We’re really keen on driving inward investment into the city, and we believe that if we have a healthy economy, and healthy people, that that helps. My background is in health; I had worked in the NHS for many years. And I joined Leeds and Partners, because Leeds has decided to focus on a small number of sectors and do them really, really well, and health and innovation is one area.

Tim Straughan

Our ambition is to be internationally renowned in leading on health and innovation. So that’s quite a big goal. And within that, we’ve set up the Leeds Innovation Health Hub, which is a collaboration of all the healthcare providers in Leeds, and all the commissioners. We have provider organizations, the hospitals and the GPs in primary care centers; and in addition, since April 1, we’ve had something called Clinical Commissioning Groups, and they essentially buy or commission services from those providers.

They’re the executive purchasers of healthcare services?

Exactly. And we’ve also got the Leeds City Council, who have responsibility for adult and children’s care, and also, as of April 1, responsibility for public health. So they are a key body, where, like you, we’re very keen on integrating healthcare and social care, to shift care out of these big, expensive hospitals, to home or places close to home, and getting people to look after their own care.

So you’re getting into population health management, as we are?

Exactly. And we’ve got a long way to go, but we’re driving up the agenda. And within the Leeds Innovation Health Hub, it’s got the providers, the commissioners, the authority, the universities, and the local headquarters of the NHS.

So while a lot happens in London at Whitehall [the British Parliament], the equivalent of a part of your HHS [Department of Health and Human Services] is in Leeds. So we’re working on a whole health ecosystem. We want to work together as one unit across the whole system, and think we can do things together and quite powerfully, with huge benefit. And we’re doing a whole number of projects, including the creation of what we’re calling the Leeds Care Record, which includes not only the hospital data, but also the GP [general practitioner: most British physicians are GPs] primary care data, and the social care data, and eventually the home care data. There are real benefits to gain. And by joining up those data sets, it’s not only fantastic for caregivers, but also in terms of the value in terms of population-based and research-based data.

When did the Leeds Care Record project go live?

We haven’t got all the things I’ve talked about in there yet, and this is where the Alere piece starts to fit in. When we started our discussions with Alere, it was on the principle that if we were able to collaborate with a partner, we could accelerate the system. Now, it’s quite diverse in the States, isn’t it? And joining it all up is a challenge. And I’ve been watching the growth of your health information exchanges. And in essence, we’re trying to create our own health information exchange in Leeds, and rather than trying to reinvent the wheel, if there are vendors on the other side of the Atlantic, we’re not going to do a big rip-and-replace; we’re going to build on what we have.

So what have you done so far with Alere?

What we’ve done with Alere and announced a couple of weeks ago, is to sign a collaboration agreement. The framework is between Alere and seven organizations in Leeds that represent the group I was talking about—the hospitals, commissioners, local authorities, and ourselves—so it’s a collaboration across the whole healthcare economy. And we’re collaborating with Alere to look at how they can help us accelerate the work we’ve already been doing with the Leeds Care Record, and bring their knowledge and technology in our setting. And their interest in telehealth and telecare is interesting for us; we’ve already got an existing contract with them on that.

What do you hope to accomplish in the next year or so?

We have a policy that we’re trying to roll out electronic care records across Britain. And we’re keen to do that ahead of most. And our ambitions are to accelerate that. Our big teaching hospital has 300-odd IT systems in it. It’s a massive hospital, the biggest in Europe. And clinicians can view the data on what’s happening in the hospital. And the GPs are live, too, but we’ve only started to put the two together. We’ve now got GP data up and running in the hospital, but not vice-versa, and we’ve got some way to get it fully functional. So we’re looking over the next 12 months, and assuming all the collaboration goes well, to effectively have, within the next year, a much better connectivity, but also a much better interface, to have the kind of connectivity that they have at Virtua in New Jersey.

What are the biggest challenges to building this health information exchange?

There are challenges around information governance; and clinical ownership and buy-in. Over the last years, we’ve had the National Program for IT, which was a big, centrally-driven program to roll IT out across the NHS, and it struggled, and clinical ownership and engagement have been one of several issues in that. Also, the interoperability is a challenge; making sure we all use the same standards, and making sure all the technology works. And there’s a big change management piece, it’s not just an IT project. But the upside is that the benefits are enormous. It’s challenging because of the number of parties involved. And as you introduce more parties and organizations, it becomes more complex. Money’s always a challenge to us; we’ve never got enough money to fund things.

And even though the physicians are employed, they may not be fully engaged?

That’s right, they still have their own minds. And even within a single GP practice, you get a vast range of different opinions. And one of the problems we had with the national program is that if you try to roll out a national program, everyone wants to customize it, because everybody thinks they’re special.

What learnings have you had so far, and what might people on our side of the pond want to know?

It’s all about the people, and you can never do enough work on education and getting people to get engaged and to buy in. So, huge learnings around that. And another is that the issues are very common around the world; and there are huge things we can learn from others. The NHS has been very bad at the whole “not invented here” thing, but that’s changing. And that’s something we want to show. And so this collaboration is quite symbolic for us. It will show a different way of working, with new partners from different parts from the world.

There’s potential in such cross-fertilization, then, right?

Exactly that, yes.

Per the U.S. healthcare system, what can you learn from us and what can we learn from you?

The U.S. healthcare system has some of the best in the world, but also some of the worst in the world; the inequalities are absolutely massive. And your percentage of GDP in terms of spending is double ours, and the outcomes aren’t twice as good. When you do things well, you do them extremely well, and those are some of the things we want to learn from and imitate. And actually, we’ve got some inequalities, too, and we’ve got some real inefficiencies here. We do far too many face-to-face interactions here, a lot of stuff that could be done much more through modern technology and innovations.

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