OpenPrescribing Newsletter November 2020

We have been very busy since our last newsletter back in July and there are tonnes of exciting updates for you here!

Measure Update: Total Oral Morphine Equivalence

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.

Hospital Medicines Data

In July, Ben Goldacre and Brian MacKenna 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.

We have written about our plans for OpenPrescribing.net/hospitals and we are now seeking funding to begin investigations into this data as well as building interactive tools. If you are a funder please get in touch!

In the meantime we have also openly shared our first analysis on the use of biologic medicines for severe asthma! Please let us know what you think! We want to build a community to help make openprescribing.net/hospitals a reality. We know lots about software, academic research and primary care medicines data but hospital medicines data is somewhat new to us. This isn’t ignorance: we just put a very high value on close skill-sharing between software developers, researchers, and clinicians with “domain knowledge”. So if you’re a doctor (maybe a clinical pharmacologist), a nurse (with a close interest in prescribing), a pharmacist (working in a hospital), or anyone else with a close working interest in this data, then get in touch!

OpenPrescribing and Bennett Institute Papers

Our papers this month cover both our love of web scraping and the influence of EHR design on prescribing behaviour. We have summarised these below. Please do share with colleagues and get in touch if anything in particular stands out!

• The BJGP has published our paper on Suboptimal prescribing behaviour associated with clinical software design features: a retrospective cohort study in English NHS primary care. We have previously described this in our Ghost Branded Generics blog. We found that a design choice in a commonly used EHR had led to £9.5 million in avoidable excess prescribing costs for the NHS in one year. However, we also report that notifying the vendor of this issue led to a change in user interface and a rapid, substantial spend reduction. Overall this finding demonstrates the significant impact that EHR user interface design has on the quality, safety and cost-effectiveness of clinical practice - expect us to say a lot more about this in the nearish future!
• As you know, in the Bennett Institute we use moden, open tools and approaches and we believe in a culture of ‘build it once, share to everyone’ and so this month we published a column in Nature on How we learnt to stop worrying and love web scraping. We talk about how we use web scrapers to collect information from clinical-trial registries, and to enrich the OpenPrescribing data set, as well as how we used a web scraper to download coroner’s reports and screen for opioid-related deaths. Having convinced everyone of the utility of web scraping, we go on to discuss exactly how it works and how anyone who wants to can get started.

OpenSAFELY News

Since the start of the pandemic, much of the OpenPrescribing team have been spending our time building and researching in our powerful new OpenSAFELY platform. Our first analyses on the factors associated with COVID-19 death in 18 million patients was produced just 42 days after project ideation and published it in Nature. Since then, the OpenSAFELY collaborative has only become busier:

• Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids (Lancet Respiratory Medicine). This observational study found no evidence to support a major protective role for regular ICS use in COVID-19 related deaths among people with asthma or COPD. This should provide reassurance that regular users of these inhalers are not at undue risk from COVID.
• Our more detailed analysis on Ethnic differences in COVID-19 infection, hospitalisation, and mortality has been shared as a preprint. We were asked to conduct this analysis by England’s Chief Scientific Adviser and, by analysing linked primary care records of 17.5 million, we found that the likelihood of testing positive, being admitted to ICU, or dying with COVID-19 were much higher among some ethnic minority groups compared to white adults. Some factors not captured in clinical records such as occupation or inequitable access to health and social services may be important, and so we advise that it is essential to prioritise linkage between health, social care, and employment data, as well as engaging with ethnic minority communities, to better understand the risks.
• Our take on the debate about Hydroxychloroquine and its role in the prevention of COVID-19 mortality has also been published in the Lancet Rheumatology. After accounting for age, sex, ethnicity, use of other immunuosuppressives, and geographic region, no association with COVID-19 mortality was observed among people routinely taking the drug prior to the pandemic. You can, as always, review hydroxychloroquine prescribing on the analyse page.

You can find out more about OpenSAFELY on our website, or follow us on Twitter @OpenSafely. As always we’re keen to hear about how we can improve. If you have any ideas or if there are any research questions related to COVID-19 that you are particularly keen to see answered, please do get in touch: bennett@phc.ox.ac.uk.

We’re Growing

As we like to say, we are a small but mighty team. However, we are growing fast! In the last couple of months we have welcomed three new members to our tech team: Tom Ward, George Hickman and Simon Davy. Tom is a consultant developer with over fifteen years professional experience working with web technologies, George is a software engineer who has previously worked with (amongst others) Mozilla and Open Health UK, and Simon is a consultant programmer with fifteen years experience of developing and operating high traffic web services. In addition, Anna Rowan - an analyst in the NHS England and Improvement Medicines Analysis Team - has joined us on a part-time secondment. We are delighted and excited to have them all in our team.

We’ll be hiring again soon so do keep an eye out and feel free to reach out if you’d like to know more about what it’s like to work with us.

In Case You Missed It

All the best bits from our previous newsletter

• Statins: The BJGP published our paper on Prescription of suboptimal stain treatment regimens which reported that, although some practices and CCGs have improved, breaches of NICE guidance on choice of statin remain common. Also included in the paper is a discussion of potential solutions to support practices and patients use of NICE recommendations.
• New CCGs and PCNs: Following the reorganisation of Clinical Commissioning Groups in April 2020, we rapidly delivered new dashboard on OpenPrescribing.net for all the new CCGs formed. You can find your CCG by using the CCG search page.
• CEBM COVID-19 Evidence Service: Over the past couple of months we have contributed to a number of evidence reviews compiled by the Oxford evidence service supporting the COVID-19 response, including:
  • COVID-19 Clinical Trials Report Chloroquine and Hydroxychloroquine
  • The FDA has authorised remdesivir for use in COVID-19 patients: but there’s no good evidence it reduces mortality.
  • Should we prescribe longer repeat prescriptions for patients with long-term conditions during a pandemic?

In Other News

Updates from our other projects

COVID-19 Trials Tracker: As you might have seen our TrialsTracker team has launched a new tracker for COVID-19 research at covid19.trialstracker.net. This takes data from the WHO ICTRP database on COVID-19 trials — including vaccines and treatments — and ensures the data is cleaned and key attributes made available for secondary analysis. Do give it a look and let us know what you think.

OpenAnalytics: As you might remember, at the end of last year we launched a new policy think tank and we’ve been busy kicking off our campaign for better use of modern open computational data science in healthcare.

21st Century Analtyics: In July JRSM published our mass authored paper on Bringing NHS Data Analysis into the 21st century which identifies the technical, cultural and regulatory barriers to the better use of data analysis to support decision making in the NHS. This month Ben and Jess (our policy lead) have been talking about this to various groups of analysts across the healthcare system. Ben presented to the Association of Professional Healthcare Analysts (AphA) conference, and at the Strategy Unit Festival, whilst Jess chatted to the Health Education England Topol Fellows. Finally, Ben and Will (one of our statisticians) chatted at the NHS-R conference. Let us know if you’d like us to talk at your event about the use of open analytics in healthcare.