Develop shared health and care analytics, which will enable us to understand the health needs of the population and to estimate how we can make the biggest improvements in improving health outcomes, patient experience, cost efficiency, workforce wellbeing and reducing health inequalities
Examine the bigger picture of the drivers of good health and provide an understanding of the relationship and variation between care received throughout different points in an integrated care system
Design how to move from reactive care to preventative care, through the use of prescriptive rather than descriptive analytics to provide a more holistic view of a patient’s requirements and care
Develop the new and collaborative ways of working across organisational health and care boundaries needed to deliver the changes that our patients and communities need
We will develop intelligence to plan and commission services based on what will offer the most value for individuals, considering every aspect of their health and wellbeing, proactively preventing poor health and being ready to best manage it when it happens.
Describe the whole picture of individuals’ health and wellbeing, how this is likely to change in the future, and what interventions would have the most value.
Identify where we can make the most impactful improvements by addressing prevention, vulnerable groups, gaps in care, inequalities and poor outcomes.
Review which interventions work well to address similar problems elsewhere, as well as where local or service specific adaptations may be needed.
Assess the holistic impact of different options before implementation.
Evaluate continuously which care pathways do and do not work well, for whom, and why.
Considers whole health pathways from prevention to end of life, including, for example, risk factors, social determinants, mental health, quality of life and health outcomes.
Allows users to extract data and to build reports themselves
Intelligence for citizens
We will enable citizens to take control of their health and wellbeing through informed decision making, optimised self-care and opportunities to influence their health and care services.
Driving innovation by working with research and industry partners
We will drive world class research and collaboration at scale that is translated to patient communities so that Kent and Medway can increase the pace of innovation in how technology is adopted.
Whole-system demand and capacity intelligence for integrated care management
We will develop a system-wide view of the flow of people and service performance, to optimise the efficiency in how our services are developed and delivered.
Modelling the flow of people across the Integrated Care System, Integrated Care Partnerships and Primary Care Networks in real time, from primary care to community care.
Mapping capacity in real-time across the system, and balancing this against demand.
Directing people to the right part of the system, to receive the right care in the most efficient way for both the patient and the health and care system.
Tracking performance targets in real-time and alerting to any issues before they happen.
By monitoring the drivers of performance to understand and predict issues.
By 2024 using data-driven algorithms in real-time to support a virtual command and control centre, and associated live dashboards.
Intelligent decision support for clinicians and care teams
We will enable clinicians and care teams to identify people who are at risk of poor health and wellbeing, match them to the most appropriate interventions, and view personalised information on likely risks or benefits to inform shared decision making.
Developing risk stratification models with acceptable levels of sensitivity and specificity, that have been validated by local clinicians.
Developing models to identify not only citizens with the highest risks, but also those who are likely to have increasing risk, and those who are likely to be most impacted by available interventions.
Routinely identifying missed elements of pathways of care for individuals and ensuring that those gaps are filled.
Providing clinicians and care teams with personalised intelligence for each citizen, so that they can inform them of likely impacts of different care options.
By 2024:
Consistent risk and impactability algorithms for that consider the whole picture of an individual’s health and wellbeing, and can be easily applied directly at the point of care by clinicians and care teams for all individuals in the population.
Decision support algorithms that alert clinicians and care teams of personalised matches to intervention options based on predicted risks and benefits.
Reduced unwarranted variation by providing clinicians with tools to compare their outcomes with peers.