Public health in hospitals – can informatics bridge the gap?

The NHS England Five Year Forward View emphasised the need for a ‘radical upgrade in prevention and public health’.¹ Community health and social care are both engaged in preventative care, but hospitals also play a key role in this agenda.² In 2014–15 alone, hospitals in England served 16 million finished admission episodes and over 100 million outpatient appointments.³ These encounters represent huge opportunities to provide health promotion at scale to individuals at high risk of preventable morbidity and mortality.

There are a number of barriers to health promotion in hospitals, such as limited resources and a tendency to focus on diagnosis and treatment of specific diseases, rather than risk factors. This is reflected in the findings of the national health promotion in hospital audits in England, which found that few hospitals met the standards for assessment and health promotion practice for important modifiable risk factors, including smoking and alcohol misuse.⁴

Clinical information systems may help overcome some of these barriers by facilitating the accurate documentation of risk behaviours in electronic health records. Standards are required to ensure these data are validated, consistent and clinically useful. A national project is being undertaken by the University of Birmingham and Queen Elizabeth Hospital Birmingham, in partnership with the Royal College of Physicians Health Informatics Unit, to develop national data standards for recording alcohol and tobacco use in electronic health records.⁵ National consultation with patients, healthcare professionals, public health professionals, IT system suppliers and informaticians, as well as literature reviews, and pilot work are being undertaken to ensure the standards are evidence and consensus based, acceptable to end users, and implementable.

The objectives of these standards are to record information on alcohol and tobacco use that:

• enables healthcare staff and clinical information systems to identify at-risk patients, and provide preventative and therapeutic interventions

• is relevant to public health and healthcare organisations to inform commissioning and delivery of preventative services and clinical audit of health promotion practices

• enables epidemiological and clinical research on alcohol and tobacco consumption among patients in primary and secondary care

• enables patient-relevant information to be shared across the healthcare system to improve coordination and continuity of care.

Implementation of these standards could enable the systematic identification of patients with ongoing exposure to modifiable behavioural risk factors and automated delivery of evidence-based interventions. For example, documentation of current smoking in an electronic health record could trigger an automated SMS message to patients containing advice on how to access NHS smoking cessation services. Recording harmful alcohol use could automatically prompt an alcohol support worker to give brief advice to patients prior to discharge. Use of health informatics in this way could potentially be more cost-effective than solely relying on healthcare staff to deliver health promotion and could be an efficient gateway to preventative services.

The development of standards for clinical information recording and better use of health informatics offers a means to improve quality and outcomes for both individual patients and the wider population, aligning clinical and public health aims.

Conflicts of interest

The authors have no conflicts of interest to declare.