1. System Watch: A web-based system to monitor and predict pressure in the Scottish health service Helen Brown University of Edinburgh Information and Statistics Division (NHSScotland)

2. Aims Monitor and predict pressure in the NHS Scotland in real time Identify vulnerable groups of patients and inform clinicians Provide a patient information system

3. Indicators of pressure Emergency admissions Beds occupied by emergency admissions Calls to NHS24 (relating to infectious illness) Flu spotter rates Ambulance emergency call-outs Local monitoring information (Weather, air pollution)

4. Real-time processing Data feeds:- –Individual in-patient records from all Scottish hospitals and NHS24 –Flu surveillance rates and 999 calls frequencies –Sent daily/weekly Data processing, calculation of predictions, production of graphs and tables as web pages Pass information to System Watch website

5. Predictions and trends Hospital data modelled to construct:- Seasonal trend: Based on seasonality, day of week, public holidays. Real time prediction: As seasonal trend, additionally using current hospital emergency activity and flu rates.

6. SHOW WEBSITE

7. Identifying vulnerable groups of patients Linkage of patient records allows their histories to be tracked, selected groups of patients can be identified For example, repeated emergency admissions in elderly patients can be identified as they arise Hospital staff and/or GPs notified by email Potential to identify other groups, eg repeated callers to NHS24 repeated admissions for self-harm, or in children

8. Providing patient-based information Tool to provide in-patient histories and NHS24 call details on request Tool to inform designated person via email/mobile when a patient is admitted to hospital Confidentiality issues to be addressed before tools are implemented

9. Planned development More data More frequent updates (eg daily), eventually automate data feeds Improve accuracy of predictions (eg include NHS24 information; consider more complex models) Real-time linkage of records New ‘products’ utilising real-time data

10. More real-time data NHS data: A&E, deaths, GP records (GPASS), prescriptions, disease registers, maternity, children, test results Non-NHS health data: –private health care –data from patient monitoring systems (eg asthma project) –hits and information entered onto personalised health related websites (advice sites, managed clinical network sites) Other person-based data: social services, police, schools Environmental: weather, air pollution

11. Real-time linkage Linkage of records on same person 3 approaches: –Record unique patient identifier (CHI in Scotland) –Link pairs of datasets using non-unique identifiers: eg name, dob, postcode (and CHI when recorded) - ‘probability matching’ –Link CHI to all datasets

12. New ‘products’ using real-time data Integrated care records Interactive interface to provide tailored information Workflow management tools, eg scheduling operations Patient monitoring and notification tools Patient level prediction tools, eg children at risk, risk of emergency admission

13. Accessing System Watch Website: www.show.scot.nhs.uk/systemwatch Login: system Password:watch (Access to NHSNet required)