Using big data to improve healthcare

13 July 2015

Interview with

Dr Lydia Drumright, University of Cambridge

In October last year Addenbrooke's Hospital in Cambridge became the UK's first toStethoscope_in_drs_hands become an 'e-hospital' and transfer patient records from offline paper copies, to online records, meaning staff can now access records even on mobile devices around the hospital and even from home when they are on call. Lydia Drumright is a lecturer in Clinical Informatics based at Addenbrooke's, and she explained why the hospital made this move to Chris Smith...

Lydia - It's about universal, high quality care for all and that's really the focus that Addenbrooke's Hospital has.

Chris - What does actually making an eHospital, an electronic hospital, involve?

Lydia - So, what it involves is taking what we used to see as paper records and we had paper records and electronic systems as you well know. In the laboratory, we had electronic systems and we had a bit a paper and everyone had to go on different systems. This is about taking all the paper, all the electronic systems and universalising them into one. So, what that means is that when you're the medical doctor as you well know, for any given patient at any given time of the day, you have 100 per cent of their medical information up-to-date right in front of you when you need it.

Chris - It sounds pretty simple though because to be fair, I can do online banking from anywhere in the world. I can move some money around on some bank accounts. Why is this a challenge when it comes to health?

Lydia - There are a number of reasons that it's a challenge. The first being, if you haven't done it before, we took everything that every doctor, nurse, and other care provider knew in the hospital and changed it on them overnight. They had to change the way they worked and the way they operated. That being said, they're working very well with it now and very pleased with it for the most part.

Chris - Where will this return benefits in healthcare?

Lydia - So, what we've done as part of Cambridge University Hospitals Foundation Trust is combine this with research and that's always been the plan from the beginning. CUH has the opportunity and the relationship with the University of Cambridge to do this and be the cutting edge so we can deliver high quality translational research. I think you and I were having a discussion before, talking about just some of the things that can happen. And out in Stanford, they talked about really important items where, when a drug goes out to market, we think it's safe, we've tried it out, but we don't know until it's been out on the market for 10, 20 years, and we don't know what the side effects will be. But we can monitor those when we are using an electronic medical record system.

Chris - Is that because rather than having to pay a human to relentlessly plough through many, many, many hospital notes, read appalling handwriting and try to work out what is wrong with the patient, what's happened to a patient, what drugs they've been taking, and all that takes time, you could write a computer program which would do that very, very quickly on a massive scale.

Lydia - Absolutely. Our team is doing that now at Cambridge University Hospital and you can also, knowing about reading medical notes - just to go back to that - and patient safety, I've been through many, many of them in my career as researcher. I think it's hard for ourselves or even other doctors to read another doctor's handwriting in the notes. Everything is clear with...

Chris - It's intentional, Lydia.

Lydia - I can't comment on that, Chris. Maybe you can.

Chris - So, what you're saying is, because we can marshal lots of data from lots of people very quickly, a) we can make new discoveries about how drugs work, about how drugs work even better under certain circumstances, but equally, we can make things safer because we can find out when things don't work so well, because we can link up and look at lots and lots of people and you've got to look at lots of people to get lots of data to find out what these differences are.

Lydia - Absolutely. There are a lot of other things that we can do as well. So, my team is looking at putting interventions in that support medical staff to help them make a system safer. We're looking at the epidemiology of people. If we can connect up all the medical records in a country like the UK with the NHS, what we can do is actually look from birth to death at what the risk factors are for each and every individual problem.

Chris - What about the one thing that people often do highlight with medical records and their personal data, the safety of that data, the integrity of that data, making sure it doesn't get hacked for example?

Lydia - I think that's a really important question and I think it's really important to share how we do that and the first being that in the UK, we have two datacentres that are to the highest NHS standards dedicated to hold this information. It is not accessible on the internet as you well know maybe being a doctor trying to look it up on call....

Chris - Allegedly, I can access this from home and I've tried and it told me I wasn't allowed.

Lydia - That's because you're not quite fitting into the security system. If you go talk to IT, they'll help you out with that.

Chris - That's kind of a good test I suppose. If its own staff can't get in, that's kind of proving that the data is secure, isn't it?

Lydia - Well, I think we want the doctors to have access to the data, but the other thing that I should highlight is that EPIC, which is the system that we bought, has been running for over 20 years in the US in multiple systems and around the world, and there has never been an external breach of the system. So, I think people should feel quite secure in that. If they don't then I can tell you what the data look like on the back end. There's no nice spreadsheet where Mrs Smith and all the details next to it. Connecting that up takes a lot of computer programming and as you well know on the front end, in order to get in, you have to have a medical log in which we can monitor and we can see everything you're doing. Not to scare you Chris. And then you have to have specific details about the patient such as their medical record number, their birth date. You can't just look people up by their name.

Chris - You say that this is the first time this has been done in the UK which is a big step forward for the UK, but compared with other countries, how do we fare?

Lydia - Compared with most high income countries, we are a bit behind in terms of getting medical records electronic and out there. That's because it's been recognised as an opportunity for high quality patient care and safety. And so, what we're trying to do now and what the Department of Health has called for, sometime between 2018 and 2020 to have all medical systems on an electronic medical record.

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