LIVING AND WORKING
healthcare
INSIDE A CONNECTED
Niels Peek tells Martin Cooper AMBCS about how northern cities are embracing learning
health systems and reveals the health and care advantages they promise.
Four northern cities are hoping to improve
patient care through using data and
technology in revolutionary ways. The
ground-breaking £20m project is called
Connected Health Cities (CHC) and it will
see experts from across northern England
collaborating closely on a project that
hopes to tackle issues like unplanned
Image: iStock.com/ktsimage
hospital admissions for patients with
chronic diseases.
The CHC project will use existing
healthcare data to generate new insights
into how practitioners can identify at-risk
patients earlier. It’s hoped the project will
also provide better support for patients
who care for themselves and to make
better, more targeted, use of
community-based care.
Speaking about the project, Rob
doi:10.1093/itnow/bwx039 ©2017 The British Computer Society
Finnigan, a kidney disease patient
from Manchester says: ‘The benefits
are enormous. By merging databases
together researchers are able to get a
more complete picture of public health
and understand how best to plan services
or prevent diseases from occurring in the
first place.’
‘The NHS is unique in the data it
collects and it is fantastic to see Health
North bringing northern cities together
18 ITNOW June 2017
HEALTH
CITY
to harness this power to benefit the
patients they serve,’ said Health and
Innovation Minister Nicola Blackwood MP.
‘This project has the potential to set an
exciting precedent of working more closely
together across regions. The ideas being
shared in the north have the potential to
be developed and used right across
the country.’
Going further, digging deeper
Adding detail, Niels Peek - a reader
in informatics at the University of
Manchester - explains: ‘It’s about
building learning health systems in the
north of England. It’s very much a
marriage between classical quality
improvement and modern data science.’
Peek is Director of the Greater
Manchester Connected Health City, and
spoke exclusively to BCS about the
learning health system project – how it
was conceived, what it hopes to achieve
and also about some of the biggest
challenges CHC faces.
The CHC project was founded to
address some familiar challenges. These
encompass: the need to reduce costs;
ever-increasing demand for healthcare; an
aging population; the rising prevalence of
long-term conditions and also the pressure
that life style factors are placing on the
health and care system.
‘To meet these demands you need to
link together data from services across
health - primary care, secondary care
and other health services.’ Achieving this,
Peek says, will provide health managers,
providers and decision makers with a
complete and granular picture.
‘There have been pockets across
England where this has happened to some
extent. The comprehensiveness with which
we’re working is new,’ he says.
Looking for outside influences
Learning health systems, such as the CHC
project, come from very mixed parenting.
Rather than being purebred medical drives
they draw inspiration from many different
industries – sectors where data has had a
profoundly transformative and
disruptive effect.
‘Think about the travel industry, retail
and music,’ Peek says. ‘There are many
examples where our lives have been
completely transformed by the internet
and ubiquitous computing. I hope we can
achieve similar things in healthcare.’
Transforming health and care so it can

be consumed like buying products from
Amazon is certainly a very compelling
vision. It’s also fraught with difficulty.
‘One of the biggest challenges we have to
overcome is the NHS’s complexity,’ he says.
The NHS is also funded with public
money. This means that health and
social care behaves, and is viewed, very
differently from businesses in those
sectors - where data has wrought the
biggest upheaval. ‘Retail is a good example,’
Peek explains. ‘It has been transformed
‘There are many examples where our lives
have been completely transformed by the
internet and ubiquitous computing. I hope we
can achieve similar things in healthcare.’
completely by data and computers. The
old players have gone and new ones have
taken over. That’s a trick we can’t play in
health care and we wouldn’t want that.’
Hospitals, unlike yesterday’s high-street
stalwarts, can’t fold.
‘That,’ Peek warns, ‘would be very
threatening to the sustainability and the
safety of our healthcare system.’
Looking forward
Acknowledging transformation’s risks and
challenges, Peek is, however, forthright in
his hope that health can learn from these
disrupted sectors and that it can achieve
similar things. Specifically, he foresees a
time when interactions between health
services and the public becomes much
more flexible and user friendly.
‘Interactions may even happen through
my smartphone,’ he says. ‘It’ll give me the
information I need. We’ll also see a health
service that’s much better adapted to the
needs of the population that it serves.’
Learning health systems also promise
to help people with long-term conditions.
Currently these are generally managed
through the primary health care system
– people visit their GP every three to six
months for a check-up. This monitoring,
Peek explains, is there to help prevent
these conditions deteriorating and also to
ensure patients don’t relapse.
The problem is, this process isn’t
infallible. ‘If you look at patients with long-
term conditions like chronic kidney disease,
asthma and COPD,’ Peek explains, ‘they
all have flare-ups. And the health service
isn’t very good at preventing those from
happening because they typically happen
between clinic visits.’
Predicting the future
Looking forward, learning health systems
can provide a solution to this challenge.
Rather than visiting your GP, your health
data could be piped regularly to the
surgery and your health monitored closely.
Any problems or potential relapses could
be detected quickly or even, through
looking for patterns and changes,
predicted. Again, Peek says, much of this –
from the patient’s perspective – could be
managed through a smartphone.
Learning health systems also promise
advantages for clinicians. Primarily they’ll
provide clinical decision-makers with
much richer and more enveloping data
about patients. At the moment important
information may be encapsulated in
different systems and spread across paper
and faxes. Carers working in a connected
health city could expect a fully integrated
view of a patient – all from within
one system.
Big data and grand scale data analysis
also promise precision medicine. To
illustrate the idea, Peek points to statins.
Today he says around 100 million people
world-wide take the drugs. ‘But,’ he
observes, ‘we know that those statins
are only effective in around one in twenty
patients. So, in every twenty people
nineteen are taking statins for no reason.’
From a wellness perspective, the story gets
worse too. It seems that some patients
are wise to the likelihood of the drug not
working, assume they’re getting no benefit
HEALTH
and stop taking the tablets.
‘We can use intelligence tools to
target treatments directly at the patients
who need them,’ Peek explains. ‘Those
treatments will be more effective and we
can also prevent a lot more side effects.
We can give the patient a much stronger
message. We can say “look, this medicine is
for you… only for you and you have to take
it.” In fact, you are one of the few people to
receive this medicine because it works so
well for you. And this is very different from
what we tell patients now.’
The right to use data
For all these advantages to be achieved,
the Connected Health Cities programme
has a huge need for data. As such, the
project has placed a great emphasis on
clear communication with the public. ‘You
need to build up trusting relationships with
the people whose data we’re using. And
we’re aware that trust isn’t a given,’
he explains.
‘One of the project’s central pillars is
the creation of a “social license” to reuse
health data for research. You can’t try to
build a learning healthcare system without
also building up that social license.’
Early on in the project, Citizen Juries
were held – expert witness presented
the case for anonymous data-sharing to
members of the involved communities.
The Juries lasted for three days
and have been very successful. At the
beginning of the process, many people
attending the sessions were defensive and
unsure. In part, Peek attributes this to the
Care.data debacle. It was an ambitious
programme aimed to bring together data
from GP practices, hospitals and care
homes all with the aim of helping the NHS
to provide better care.
Despite its intentions, Care.data was
hobbled by a disastrous PR campaign.
Few people had heard of the drive until
they read lurid headlines in the tabloid
press about sensitive data being shared
with commercial entities – all without
the patient’s explicit consent. The Citizen
Juries do appear to be working very well.
Attendees often change their position from
one of resistance to one of embracement.
June 2017 ITNOW 19
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