Developing a Diabetes Dashboard to support population health improvement

Digital Transformation Senior Project Manager’s perspective - David Waterton on developing Diabetes Dashboard

The project of developing the Diabetes Dashboard was delivered in three stages:

1.reviewing the read codes to reduce variations in coding

2.consulting the stakeholders on data to be included into the dashboard

3.piloting the solution

Reviewing the read codes

The first objective of the diabetes dashboard is to review the read codes used by the GP practices with the aim of reducing variance in coded data. When this data is shared with other Diabetes Care Providers (as part of the integrated diabetes care record), reducing variability of codes will support colleagues to interpret the record. If we imagine a community podiatrist seeing 20 patients in a clinic, from 20 different practices with each patients record having different codes and structure, it would be challenging for the podiatry staff to interpret the information. The dashboard helps us to identify the common codes used across Oxfordshire and allows us to create content to support practices such as protocols and templates to support consistent capture of information using a tighter set of codes.

When the Diabetes Information is shared across multiple care providers, an integration engine will need to process rules in order to present information across systems. The dashboard will help us to provide the processing rules for how to manage and handle information from practices as we will understand the data being processed.

When we have a defined cohort of data coming monthly from the GP practices, we will have a really clear picture of how practices are recording information.

Diabetes Dashboard screenshot

Consulting the stakeholders

We liaised with key stakeholders from across Oxfordshire including the Clinical Commissioning Group (CCG), Oxford University Hospitals NHS FT (including Oxford Centre for Endocrinology, Diabetes and Metabolism, Oxford Eye Hospital), Oxford Health NHS FT, and Primary Care Practices. We consulted Diabetes Consultants, Specialist Diabetes Nurses, General Practitioners, Practice Nurses, Dieticians, Podiatrists, and Business Analysts to identify what information and codes that would be important to measure.

For the codes in the GP practice, we organised the information into specific keys areas

· Oxfordshire Diabetes Register

· Diabetes Care Processes

· Diabetes Structured Education

· Diabetes Complications

Information from Secondary Care (SUS Data) was organised into Admissions & Appointments

· Urgent Care and Non-elective Admissions

· OCDEM Consultant Appointments

· Eye Hospital Service Appointments

· Diabetes Specialist Outpatient Appointments

· Diabetes Dietetic Appointments

EPACT Data from Medicines Optimisation Teams looks at GP prescribing data

· Diabetes Prescribing

The dashboard is flexible and can be modified according to new data sources eg coding of learning disabilities in primary care, coding of structured education provided by secondary care etc.

Piloting the Diabetes Dashboard

Initially for proof of concept, we will be asking a small cohort of practices to run reports and self-submit the data for processing, this will be acceptable for a short period but will be an increase in workload if a slicker solution is not identified sooner.

We are also working on implementing a solution that allows us to capture this information centrally rather than relying on practices to self-submit data. This new solution will mean we are able to run the reports on behalf of the practices ensuring timely access to the information and removing this additional workload from the practice.

We expect the first two or three months to show lots of red figures as we tweak and amend the reports and reporting rules, this will be communicated to the practices so there are no surprises with lots of ‘red data’.

Communication with the practices is key. The dashboard is a tool that can help identify how Diabetes is being coded across Oxfordshire. If one practice is RED and another practice is GREEN, we can share learning or look for opportunities to understand how practices work differently.

Future of the Diabetes Dashboard - a flexible and adaptable solution

The dashboard is a tool and can have additional lines added or items removed, it can be adaptable to the needs of the organisations using it. The weightings of Red/Amber/Green can be specified depending on what is a priority in the reporting period. The dashboard isn’t restricted to Diabetes & can be used for any health initiative.

Clinician’s perspective - Dr Rustam Rea on his experience of being consulted on the Diabetes Dashboard

The process of developing the Dashboard gives me confidence that this solution will be valued by healthcare professionals across the services involved in providing diabetes care in Oxfordshire. The aim of the Dashboard is that it will improve the quality and efficiency of diabetes care across Oxfordshire for many years to come.

Firstly, an agreement among a wide selection of healthcare professionals was reached on what data we wanted to share and how we wanted to present it. The wide reach of this consultation process and seeking input from all involved in providing and receiving diabetes care reassures me that when I discuss data with other healthcare professionals we refer to the same information and we are using the same language to talk about it.

Secondly, the idea of capturing data centrally instead of practices submitting data, taking the burden of managing multiple databases in primary care, increases chance of having access to real time and reliable reports. The timeliness of the reporting is one of the great strengths as well as merging data from a number of different sources.

And thirdly, another strength of this solution is that the dashboard can be adapted accordingly to newly developed process and outcome measures therefore it will be useful in years to come. We aim to create a sustainable model of integrated diabetes care and therefore having a flexible tool is vital.