Latest news and views from around the Bennett Institute
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.
This repository contains the data cleaning notebook, all necessary datasets, and the code for running the COVID-19 TrialsTracker website at covid19.trialstracker.net. Docker files are included to ensure a consistent environment for reproducibility.
The following is a rapid analysis of the “top 10” medicines in NHS England primary care in 2019. We prepared this analysis for a user who wanted to use the list in a teaching session with students to prepare them for the medicines they will most commonly see in general practice. We are sure others will find it useful — please get in touch and tell us how you use it via Twitter or feedback@openprescribing.net. As always our analysis with complete analytical code is openly available on our GitHub page. You can also investigate the prescribing of any medicines you like using our tools like our Analyse page, chemical trends and our brand new browser for the NHS Dictionary of Medicines and Devices. Read on below where we describe the “top 10” medicines and class of medicines, in terms of volume and cost.
Covid-19 shows that we must overcome organisational barriers to deliver clean, realtime, standardised data in support of direct care, system planning, and urgent response
At the Bennett Institute we like to work in the open and share our insights for the whole community, so we can fix a problem for us, then share the solution, and help fix it for everyone. We think this is efficient for us and the whole system. In this blog our magnificent coder Peter Inglesby sets out some analysis he has done of changes to the NHS prescribing data we use. It took us a few hours to investigate these problems for our own purposes, then document our findings and solutions internally; it took an extra 20 minutes to share in this blog post and now we give it to you so you don’t have to replicate our effort and can maybe find some insights we have missed!
Update September 2020: NHS England have announced a reduction in the number of planned measures including the majority of the measures on OpenPrescribing. We will remove the IIF dashboard in a future update.
Update: Due to COVID19 response NHS England has announced that the IIF will be postponed. We will continue to make this dashboard available as NHS England also states that they will continue to monitor the data to understand any impact.
At the Bennett Institute we get many people contacting us every month asking us when OpenPrescribing will be available in their country. In this blog we are outlining OpenPrescribing.yourcountry where we give you the information that you can use locally to build a case for OpenPrescribing in your country and obtain funding to support development. We aren’t quite ready to build OpenPrescribing.yourcountry yet, but we will be soon and we wanted to share our plans so you can be ready when we are.
Most people share their end of year roundup during late December when everyone is too full of cake to read. Now you’re back in the saddle, here’s our roundup of everything the Bennett Institute threw out into the world over the previous 12 months!
OpenPrescribing.net went from strength to strength, with over 135,000 unique users last year. We now have over 80 measures of prescribing safety, efficacy and cost-effectiveness and have been working on new types of measures and alerts to identify “outlier” prescribing, such as with zuclopenthixol. In 2019 we also: launched new dashboards and bespoke alerts for every single primary care network (PCN), sustainability and transformation partnership (STP), and NHS region; upgraded the Analyse page to support more organisations with bespoke medicines queries; and developed tools to help solve the problem of Ghost Branded Generics which cost the NHS an extra £11.6million per annum but has massively reduced during 2019.
This is the repository containing everything you need to recreate our analysis published in The Lancet assessing compliance with the Final Rule of The Food and Drug Administration Amendments Act (FDAAA) (2007). The code can also be easily adapted for future analyses of interest using ClinicalTrials.gov data.
Today on OpenPrescribing.net we have launched our Greener NHS prescribing dashboards. Over recent months there has been increasing attention on the environment and the effects society is having on climate change. The NHS announced specific targets as part of its long term plan to become more sustainable, reduce waste and shift to lower carbon inhalers. At OpenPrescribing we have already launched our first prescribing measure related to the environment and this week we are launching our Greener NHS prescribing dashboard for every single general practice, primary care network (PCN), clinical commissioning group (CCG), sustainability and transformation partnership (STP), NHS region and for the whole of England.To access your Greener NHS prescribing dashboard, simply go to your organisation’s measures page and select “Greener NHS” from the drop-down. You can read more about our categories on our blog or watch our short Youtube video.
