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       #Post#: 125--------------------------------------------------
       The Importance of Relevant Clinical Information
       By: admini5 Date: May 12, 2015, 4:54 am
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       While the original QIPP programme was initially designed to
       cover 2010/11, current planning assumptions are based on a
       continued squeeze up to 2021/22 to reduce spending from a
       current level of 8% of GDP to just over 6%. To consolidate the
       £3.8 billion Better Care Fund budget for 2015/16, providers are
       required to cut emergency and elective activity to free an
       additional £1.8 billion of NHS allocations. The current funding
       constraints are more severe and sustained than ever. They come
       during a major reorganisation and cannot be addressed by
       reduction of quality (4h A&E, RTT, 12h admission, 2w cancer,
       etc.) due to CQINN targets. In consequence, large deficits are
       now forecast for trusts and CCGs where unsustainable measures
       are in place (e.g. freezing pay, PbR tariff reductions,
       prescribing). In the face of this, trusts and CCGs need to think
       and act more collectively about their local health economy and
       seek guidance on how services in all local healthcare settings
       are provided.
       To this end, they should rely on information that is clinically
       relevant and can drive clinical change and is not based purely
       on statistics and variances. Information for QIPP/CIP
       initiatives that is based on variances and statistics does not
       take into account real people with clinical needs. It often
       informs clinicians that there may be a certain number of
       patients that have similar conditions or that there are too many
       referrals, attendances or admissions based on national or local
       benchmarks. However, such information alone seldom leads to
       successful initiative implementations due to the cross over from
       statistical to clinical information domains. For example,
       weather data should be used to predict the weather, not the
       number of birds in the sky – although there might be a
       loose correlation.
       On the other hand, QIPP/CIP information based on clinical
       information including patient history, presenting acuity and
       severity, and future risk scores can be mapped against service
       definitions of initiatives successfully implemented elsewhere.
       Identification of patient cohorts based on clinical metrics that
       are in need of a local service leads to successful services and
       better patient outcomes. Since no information domain cross-overs
       occurred (clinical information for clinical services), the
       “language” and service definitions are consistent
       supporting implementation and change management.
       The challenge here is that there are hundreds of successfully
       implemented QIPP initiatives within the NHS with different
       service specifications making it hard to find the ones relevant
       for your CCG or provider trust. Also, without the ability to
       monitor ongoing implementations, incentives to encourage
       improvements are difficult to manage in the short term. A system
       is required that helps CCGs and trusts identify, impact-measure
       and monitor initiatives before they are included in medium to
       long term strategic planning or piloted for testing. Such a
       system should also have the ability to monitor ongoing
       initiatives on a monthly basis. Furthermore, this system should
       use clinical information to find clinical services, calculate
       the total opportunity and also allow demand simulations for many
       different scenarios (not just best and worst case).
       The King’s Fund has highlighted the fact that health
       economy or region-wide service changes can be planned and
       progressed via collective action by national organisations and
       academic health sciences identifying and modelling service
       reconfiguration. With the provision of clear evidence based on
       clinical metrics, greater clinical engagement and leadership can
       be achieved leading to successful change management. In other
       words, by addressing these clinical drivers, unwarranted
       variations can be tackled and sustainable levels of change based
       on suitable QIPP/CIP initiatives can be achieved.
       i5 Health as developed the Commissioning Opportunities (COP)
       report and tool-set that enables identification of QIPP/CIP,
       Co-Commissioning and BCF initiatives based on clinical metrics,
       not statistics, using de-identified local or regional activity
       data. By applying hundreds of service specification rules to a
       CCG’s or provider trust’s activity data, i5 Health
       has that ability to match real patients to real initiatives
       providing actionable results that lead to real results.
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