Latest news and views from around the Bennett Institute
On our first anniversary, from the Policy Lead in the Bennett Institute, this is the brief story of the positive side from all our lives: how OpenSAFELY came to life, and what we’ve achieved so far.
Our latest newsletter including information on: new job roles, hospital only measure, total oral morphine equivalence measures, OpenPrescribing and Bennett Institute Papers.
This is a draft discussion paper, the first of a series exploring “open team science” approaches to managing health data, and specifically how to create a collaborative computational data science ecosystem where the sharing and re-use of objects such as codelists and code is facilitated, encouraged, recognised, and rewarded. As a microcosm of this we have first explored “codelists”. There are currently no ‘answers’ or preferred solutions given. We will be holding an open discussion with the research community on 2nd March at 3pm - you can book to join us here.
We have been very busy since our last newsletter back in July and there are tonnes of exciting updates for you here!
The Faculty of Pain Medicine has recently updated their recommendation on oral morphine equivalence (OME) which we use on our OpenPrescribing measure of OME. We have taken this opportunity to update and a new novel implementation of how we assess OME. Until this work is completed we have taken the decision to “suspend” the measure from dashboards however you can still view the old method using this link.
In July, Ben and Brian wrote a piece in the British Medical Journal arguing that hospital medicines data should be openly shared. Magnificently, the NHS has now made secondary care medicines data (SCMD) available. You can read the full technical specification of the data here but briefly: it is hospital pharmacy stock control data, which is collected and processed by Rx-Info, and is now published on the NHS Business Services Authority website in the NHS dm+d standard we know, love, and have documented well.
This is the code related to our OpenPathology project. Specifically this repo stores ad-hoc analyses, papers, and related research.
The code for the website (and online tool, when developed) are in their own repository.
This is the website code for openprescribing.net - a Django application that provides a REST API and dashboards for the English Prescribing Dataset published by the NHS Business Services Authority. Information about data sources used on OpenPrescribing can be found here.
This is the code for the OpenSAFELY cohort extractor tool which supports the authoring of OpenSAFELY-compliant research, by:
It is also the mechanism by which cohorts are extracted from live database backends within the OpenSAFELY framework.
This is the repository for the OpenSAFELY job runner. A job runner is a service that encapsulates: the task of checking out an OpenSAFELY study repo; executing actions defined in its project.yaml configuration file when requested via a jobs queue; and storing its results in a particular locations.
The documentation is aimed at developers looking for an overview of how the system works. It also has some parts relevant for end users, particularly the project.yaml documentation.
This is the code for the OpenSAFELY job server designed for mediating jobs that can be run in an OpenSAFELY secure environment. The Django app provides a simple REST API which provides a channel for communicating between low-security environments (which can request that jobs be run) and high-security environments (where jobs are run).
Working on behalf of NHS England we have now built a full, open source, highly secure analytics platform running across the full pseudonymised primary care records of 24 million people, rising soon to 55 million, 95% of the population of England. We have pursued a new model: for privacy, security, low cost, and near-real-time data access, we have built the analytics platform inside the EHR data centre of the major EHR providers, where the data already resides; in addition we have built software that uses tiered increasingly non-disclosive tables to prevent researchers ever needing direct access to the disclosive underlying data to run analyses; code is developed against simulated data using open platforms before moving to the live data environment. Everything has run smoothly. We are fully live inside TPP; we are signed off with full data access and end-stage tech development for the computational platform with EMIS.
It has been a busy month for paper publication at The Bennett Institute. We have written a brief description of the most recent papers below. Please sharewith colleagues and get in touch if you have any relevant observations! Remember you can read all our academic papers related to OpenPrescribing on our research page.
Hospital medicines data: We are frequently contacted at OpenPrescribing about when we are going to make a hospital version. Unlike primary care, access to hospital medicines data is restricted. The BMJ have just published our Bennett Institute article about why we think The NHS deserves better use of hospital medicines data.
Update May 2021 Based on feedback received from users, the NHS dictionary of medicines and devices has decided to cease maintenance of the “hospital only” value at AMP level (it remains at AMPP level). As a result this means that we are no longer able to produce our “Hospital Only measure” and we have retired it.
Just prior to the COVID-19 emergency we launched a new measure on OpenPrescribing, primary care prescribing of medicines defined by the NHS dictionary of medicines (dm+d) and devices as “hospital only”. In this blog we set out what exactly this means, describe some of our early investigations and interesting (but nerdy) details, and ask for your help in improving and maintaining this dm+d field.
A guest blog from Dr. Kevin Barrett (Twitter @DrKBarrett).
Last week the British Journal of General Practice published our paper on unsafe prescribing of methotrexate. As part of the publication Dr. Kevin Barrett talked to BJGP (see video below) about how he used OpenPrescribing to identify potentially unsafe prescribing in his practice and has also written a short blog below.
When I first started as a GP trainee in 1999 electronic prescribing was a relatively recent innovation. The practice formulary was built by hand, and prescribing analysis only occurred when paper Prescribing Analysis and CosT (PACT) reports were sent to the practice. These evolved into ePACT reports, but these still required time to decipher. With the advent of Primary Care Trust (PCT) and then Clinical Commissioning Group (CCG) employed pharmacists who had the time to analyse the data and present practice- and prescriber-level data to us at a range of meetings we became used to comparing our prescribing data to our peers. Electronic prescribing aids are a useful measure to help guide our prescribing and keep us up to date with the ever-changing local and national recommendations.
This week the British Journal of General Practice published our latest paper on unsafe prescribing of methotrexate. We found that the prevalence of unsafe methotrexate prescribing (10mg tablets) has reduced but remains common, with substantial variation between practices and CCGs. In the paper we also discuss recommendations for better strategies around implementation.
Anyone can view the live data on unsafe methotrexate prescribing at openprescribing.net/measure/methotrexate, to support audit and review in your local organisation. Read the paper here and you can watch Dr. Kevin Barret (twitter @drkbarret) describe here how his practice used OpenPrescribing to identify a breach of their practice policy on methotreaxte prescribing and fix it!
At OpenPrescribing we know that clinicians can be overwhelmed with guidance and data about many different aspects of care. We therefore have developed an innovative email alert service for every single practice, primary care network and clinical commissioning group in England that delivers bespoke custom emails to your inbox about your own organisations prescribing.
To sign up to your organisation’s alerts all you need to do is:
These email alerts help people keep track of their prescribing trends, alert you to changes in prescribing that may be difficult to spot and importantly tell you if your prescribing has changed in comparison to your peers. You can see an example of an OpenPrescribing practice email alert here and you can read more about the methods in our paper.
OpenSAFELY is a new secure analytics platform for electronic health records in the NHS, created to deliver urgent results during the global COVID-19 emergency. OpenSAFELY is a collaboration between the Bennett Institute, the EHR group at London School of Hygiene and Tropical Medicine and TPP who produce SystmOne. OpenSAFELY is now successfully delivering analyses across more than 24 million patients’ full pseudonymised primary care NHS records. The first analysis from OpenSAFELY is Factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients with more answers to important questions expected shortly.
OpenPrescribing.net has been updated this week with the latest release of prescribing data covering March 2020. In-depth analysis will be needed over the coming months, but this release gives us the first glimpse into the impact that COVID-19 has had on prescribing. At the Bennett Institute we have been quite busy with the new secure analytics platform OpenSAFELY but the following blog is a rapid analysis of the March prescribing data which others may find helpful to focus their own investigations. As always, all our analytical code is openly available on our GitHub for inspection and reuse by anyone.
