Mohammad Al-Ubaydli’s blog

Dr Foster

Posted in People / organisations by Dr Mohammad Al-Ubaydli on May 7, 2006

Last month I visited Dr Foster Intelligence as part of my trip to speak at the RSM. I was blown away by what I learnt from the staff, Ellen Klaus, Head of Operations, and Professor Simon Jones.

Ellen showed me the innovative marketing operations that she runs. For example, the company has produced health information leaflets for the Department of Health.

However, you would never know this from looking at them. For a start, they are interesting to look at, reminding me of the popular magazines that most people gladly pay money to read, like Bella, Men’s Health, Hello and Us Weekly. Inside are interviews with celebrities in which they discuss their life and work. The editors have cleverly steered the discussion towards health topics, and my personal favourite is Girls Aloud‘s description of their tips for staying healthy on tours. Nadine apparently stays off the alcohol and describes her “trusty OJ recipe”. An honourable mention must go to Rachel Stevens, who exhorts on the cover “Put one hand down your trousers, boys”.

I cannot overemphasise how good these magazines are.

Ellen’s team also ran a diabetes screening project, a double-decker bus that went round Slough. They diagnosed several hundred presymptomatic diabetics, at the cost of around 50 pounds per patient if I remember correctly, astonishingly good value – remember that a single GP appointment would cost at least that much per patient, plus the nurse’s time and equipment costs. Finally, my guess is that many of these patients were from demographics that would only have presented to the healthcare system much later in the disease process, with problems that would have cost a lot more to deal with.

Dr Foster Intelligence Real Time MonitoringFinally, I am grateful to Simon for the time he spent showing me the company’s Real Time Monitoring products. This has also been described by the company’s chairman, Tim Kelsey, at a Cambridge-MIT Institute workshop, and I have a copy of the presentation.

The data for this comes from forms that clinicians fill out all day in the NHS. I remember the A&E consultant I worked for spending time to make sure that we all knew that all those forms had to be completed correctly. It now became apparent that if they were not filled out properly the hospital would not receive payment for treating the patient.

I could easily see this because the software could show me (anonymised) details about each patient’s treatment and how much the institution billed for the treatment. Incorrect form = no payment. Clarke’s separation between provider and payer has finally come of age, and under a Labour government. There are many critiques of this, but the RTM products finally show the advantages.

Here are some of the questions that the software allows to be answered:

  • How much did my patient cost when I referred her to the local hospital for treatment? How much is the average cost for the treatment of this condition (including subsequent complications) in the rest of the region, and the rest of England?
  • How much did my patients cost me in diabetic complications last year? How much would preventative treatment for the population have cost me instead?
  • How often do my hip replacements patients suffer from primary, secondary and tertiary complications? How am I doing relative to other surgeons in the region and country?
  • How often do local GPs pick my hospital for referring orthopedic patients? Why has this rate dropped in the last year?
  • How is this hospital doing in preventing deaths for conduction disorders and cardiac arrhythmias?

The latter question is answered in the screenshot, using CUSUMs. The cumulative summation technique (CUSUM) is a risk-adjusted outcomes measure intended to help clinical centers identify persistent, clinically relevant changes in performance over time. Of course, the data is adjusted for the local patient population.

My guess is that this sort of analysis is only possible in the UK – only there have so many patients (50 million) had so much of their medical records stored electronically, shared centrally, and the data analysed so impressively.

But the next challenge is to make sure that doctors understand how to use the software. My guess is that the clinicians have spent so much time filling out the forms that they resent the whole system. My guess is that they end up ignoring its benefits, ie Dr Foster’s software. The software probably ends up being used by local IT or statistics departments, ie individuals with low political capital in each institution, unable to conduct the right clinical analysis, and ignored when they make recommendations using the software. If that were the case then it would be a tragic waste of such a wonderful resource.

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