Problem

Patients might reasonably expect that their medical outcomes are used to help doctors make treatment decisions for other patients. However, this is not always the case. A common dilemma facing clinicians is the most appropriate treatment decision in the absence of evidence from randomised clinical trials (RCTs) or clinical guideline recommendations about similar patients.

For example, a patient who has both cirrhosis of the liver and atrial fibrillation (AF), poses a treatment dilemma for the doctor because AF is usually treated with anticoagulants to lower stroke risk, but cirrhosis is known to increase the risk of bleeding. There are no trials or guidelines to help the doctor, and currently, there is no mechanism in the NHS to learn from the treatment and outcomes of previous patients with both conditions.

Solution

In this project, the team led by Bryan Williams at UCLH, seek to utilise large scale NHS data to demonstrate how learnings can be generated for patient benefit. Doctors ordering blood tests or MRI scans is the norm, but here they will test out the first UK prototype of an ‘Informatics Consult’ platform where doctors can order the analysis of large-scale data relevant to their particular treatment decision, and return results within clinical timescales. They will also evaluate the prospects of scaling the tool across disease areas and diverse healthcare settings.

Impact and Outcomes

Building an open-access resource will curate and disseminate insights from the Informatics Consult and provide clinicians with new ways of data-informed decision making. Evidence from Informatics Consults could transform health and care by providing new ways of registering treatment uncertainty, identifying the need for new RCTs design, and facilitating targeted recruitment into trials.

The project could also demonstrate how an Informatics Consult approach builds patient and public trust and involvement in putting the use of NHS-wide data at the heart of efforts to deliver benefits to individual patients.

Catalyst Project Team

Project Director: Bryan Williams, UCLH and the NIHR UCLH/UCL Biomedical Research Centre