As a physiotherapist on the frontline, a service manager, a commissioner and performance manager I have come to love and loathe healthcare data. In this article, I will share my personal overview of the issues I see in the application of data management in healthcare.
1. Ticking the box
For clinicians, the priority is the patient interface, not the collection of data, making data entry a chore for many of us. The history of data collection in healthcare is mostly for research or contract purposes as a separate entity to the clinical record. For most clinicians this makes data entry a secondary task that appears to tick a box for management purposes rather than be integral to patient care.
2. Information sharing
Sharing of clinical information is seen as a positive step forward and yet this is seen as a major challenge in the current climate. The relationship between a clinician and patient is founded on trust, and on the understanding that the information given within a care episode will only be shared if necessary, and only with those who need to receive the information. Making a judgement on this across organisational boundaries is difficult and creates barriers to integration of information.
3. The patient’s story
Patients often express frustration that they are asked the same questions by different people. Some of this is about poor information sharing but for most clinicians the factual questions are a useful way to create a rapport with an individual before approaching more challenging questions that support the assessment process. We need to reduce duplication of information for our patients, while still creating a strong working relationship and facilitating thorough assessment.
Creating data definitions for subjective opinion is much more challenging and yet this is the cornerstone of a clinical assessment. Within any information system, data definitions are a way of reducing errors and improving communication. This is relatively straightforward with facts such as ‘total hip replacement carried out’ but with descriptions of symptoms such as ‘pain in my knee’ it is a much more difficult task.
5. What will data be used for?
In the health system there are three main uses of data; clinical – the data held within the record which requires specific actions such as annual review of disease; contractual – the data that supports the transactional monitoring of a contract and enables the financial and quality function; and commissioning – the data held at a population level used to plan health services and monitor the health of a locality. The data that may be available may not actually be suitable for the purpose for which it is needed.
6. Separation of roles
Analysis of information often occurs outside of the clinical team and so any inconsistencies in information are harder to spot and resolve. Questions such as ‘does a blank box mean not applicable?’ and ‘what level of coding hierarchy is being applied?’ cannot be answered without consultation with the teams entering the data in a timely manner – not always easy in healthcare and commissioning.
7. Information governance
The rules and regulations around the use of information are the source of much confusion across the healthcare setting. Myths that surround the use of information are often used to block integration of information.
8. People are not machines
Patients cannot be reduced to numbers and codes. In healthcare situations the key information points that can be coded are not sufficient to describe the holistic position the patient is in. At first look it is hard to see why healthcare is so far behind in terms of patient access to information, however, the rich language used by professionals builds a picture that supports their decision making as well as recording the outcomes. This level of information is the most challenging to manage, share, and analyse.