A discreet dash to dashboards

The pre-election purdah on government announcements is proving a mixed blessing for NHS Connecting for Health. On one hand, the agency is spared having to engage with dismal news stories about the deployment of national programme systems in acute care. On the other hand, it is having to keep mum about a success story. With little press coverage and almost no controversy, a 15 month country spanning effort has assembled the building blocks of a genuinely transformative health informatics product, the Clinical Dashboard. The technology has the potential not only to prevent disasters such as the excess mortality at Mid Staffordshire but to comply with efficiency demands in the post-election public spending regime. Digital dashboards integrate information from different sources into a unified display that can be read at a glance. Several software firms, including Hewlett Packard and Microsoft, offer generic products. In a healthcare setting, the technology can give clinicians instant access to NHS data captured locally in a way that can be compared with regional or national metrics, and best professional practice. The idea is to create a system that presents information in an easily digestible format with high visual impact; brings together multiple sources of existing data; makes clinical information more relevant to multi-disciplinary teams; provides information in near 'real time'; and allows configuration to local needs and comparison against comparative data sets. However despite the obvious applicability of the concept to the NHS, dashboards did not become part of the NHS IT strategy until Lord Darzi's 2008 Next Stage Review. Darzi's recommendation, echoed in the Health Informatics Review, resulted in NHS Connecting for Health setting up a pilot scheme to develop and test clinical dashboards in a broad selection of care settings. Prototype dashboards were developed by teams at NHS Bolton primary care trust, Homerton University Hospital trust and Nottingham University Hospitals. In the next stage, Connecting for Health awarded supplier System C a contract to develop dashboards in clinical specialities. A pilot phase, which ended in March, delivered 24 dashboards across England's 12 strategic health authorities. The pilot sought to establish a dashboard project in each SHA encompassing development of dashboards in clinical specialities and the wider local health community, such as general practice or other community based clinical teams. The pilot included dashboards for strokes, urology, ear nose and throat and for a GP practice to monitor its patients' use of acute care. Pilot for strokes The stroke dashboard, piloted at Salisbury NHS Foundation Trust, allows data collected in the multi-disciplinary in-house designed Stroke Database to be displayed and used for compilation of the national and local stroke strategy contract and audits. The dashboard also provides information to help clinicians improve the quality of care to stroke sufferers. The GP referral dashboard allows GPs to see at a glance how many patients from the practice have been admitted to A&E, or been referred to hospital for outpatient appointments. At Bolton PCT the dashboards use two different sets of metrics to display timely and relevant clinical information. The Practice Improvement Programme (PIP) metrics present information to GPs in relation to their practice performance. This data gives practices the ability to identify their strengths and weaknesses and allows comparisons to be drawn against other GP practices. A source with knowledge of the pilot project says that results include improvements to the quality of care, employee satisfaction and to data quality - information displayed locally feeds back into more accurate capture - reinforcing "capture once, use many times" behaviour. Simon Eccles, medical director for NHS Connecting for Health, says: "We've got lots and lots of information in the NHS about the quality of care we are providing, but it tends to be three months, six months sometimes even a year behind times, and it tends to be locked in silos." At Eccles' Hospital, at Homerton in London, an emergency dashboard displays measures such as the turnaround of pathology and radiology tests, and how quickly ambulances are getting back on the road. These measures provide an early warning of any problems, allowing staff to take action before they come to ahead, Eccles says in a video on Connecting for Health's website. However he warns that a clinical dashboard cannot be installed off the shelf. "Clinicians need to talk to their whole clinical team and to the management of that team in order to work out whether this is the right tool for them. They're not designed as a performance management tool to help make clinicians more efficient they are a clinical tool to help a team to improve its quality of care." Outside the national programme, several NHS organisations are installing dashboard type technology to get a grip on costs. In Manchester, specialist cancer unit Christie Hospital NHS Foundation Trust has chosen dashboard software from Dynistics to provide a visual graphical representation of key performance measures. These represent the resources consumed by each patient from the time of admission until the time of discharge. Sarah Vassie, finance manager at The Christie, says: "We'll be able to analyse everything from the cost of the patient through his or her 'journey' in the hospital, to departmental cost analysis, speciality and disease group costs and drill down lower to identify the cost of individual patient procedures - invaluable information for managing the trust." Like picture archiving and communication systems (Pacs), the clinical dashboard appears to be the right technology at the right time. The danger now is that in a political climate of nervousness about anything to do with IT, the tools will languish on the shelf.