The Big Interview

The Big Interview: Dr Tim O’Sullivan

SWBR’s Kathryn Penaluna talks to Dr Tim O’Sullivan, Head of Research and Academia at NHS Wales Informatics Service, about fighting the spread of COVID-19 with data.

Tell us about your professional background.

My first exposure to IT came in the form of punch-cards and FORTRAN 77. This eventually led to a move into medical computing, including a brief stint at UCLA looking at ‘Expert Systems’ (now known as Artificial Intelligence). But my first day in the NHS, the morning after Chernobyl, made a bigger impact. Employed at Brighton Health Authority as a Research Analyst, I was immediately redeployed to work on mapping potential radioactive fallout and dealing with something called ‘the media’. At the time, I’d barely ever answered a telephone. It felt like chaos but expecting the unexpected has always been part of the attraction.

What is your role now?

To help sort COVID-19, whilst trying to keep an eye on my day job which combines leading on research and being an academic liaison on behalf of NWIS Information Services Directorate. My team also manages and improves the services we provide to Welsh Health Boards, Trusts, Primary Care, Welsh Government, Public Health and most importantly of all, clinicians, patients and the public - all of whom are increasingly dependent on technology, digitisation and data. These services include provision of health statistics, business intelligence, data warehousing, systems design, standards and strategy advice. Our role and function is being transformed by data science, big data and advanced analytics - there has been much partnership development and Welsh Government investment recently as part of the National Data Resource (NDR) strategy, so we’ve had an influx of new skills, resources and partnerships.

What initially attracted you to this role?

The opportunity to apply skills learned elsewhere and do something useful, varied and challenging. Work pressures are high, but if you enjoy improving healthcare via the use of health informatics, Wales is a great place to work. Everyone seems to know each other - or at least of each other - making rapid progress and working across organisational boundaries much easier. The boundary between work and play is also pleasantly blurred at times – everyone should have an element of creative fun in their job.

How has the onset of the Coronavirus pandemic changed your responsibilities?

Along with many colleagues, I’ve been working pretty much full time on COVID-19 since the end of February, when I did some crude but sobering worst-case scenario modelling, applying Welsh data to Wuhan survival rates. A few of us also started to pull together a ‘brain-dump’ of our services that might be critical along with new work that might come our way if the pandemic reached Wales. In late February, we shared a possible work programme, which was soon enacted.

We had two initial focuses: the first, a virtual COVID-19 Datastore based on our existing Data Warehouse, bringing together and integrating existing and new dataflows likely to be required and exchanged by us, Health Boards, Public Health and other clients during the pandemic. This has quickly expanded and developed into a key resource. The second, the COVID-19 Datahub, was developed to signpost and promote the use and sharing of data via a single accessible product comprised of reports, dashboarding, data download facilities and supporting metadata. The Datahub now has over a thousand registered users and continues to expand in terms of content and functionality. Since March we’ve also supported a succession of urgent COVID-19 projects and requirements - for example, helping Public Health Wales with disease surveillance, health intelligence data provision to Welsh Government, facilities for more timely mortality recording and reporting, and probably most positively, development of systems for managing and reporting on vaccine deployment.

While working at the NHS, have you noticed any interesting progressions in how the organisation uses data?

Historically, expectations of and investment in technology has outstripped our understanding of how best to use information. Data has also tended to reside in organisational silos, with the most useful clinical information locked away. Processes for national data flows and the production of official statistics have also remained largely unchanged for decades and have tended to be dominated by the need to support performance and administration rather than clinical, citizen and broader population health requirements.

But with the advance of Once for Wales shared clinical systems; development of powerful Business Intelligence tools that can help unlock data; investment in programmes such as the Value Based Healthcare initiative; the establishment of the National Data Resource with its aim to deliver big data solutions and data science products that can be used by NHS, academic and other sector partners; and investment in academic partnerships such as the Networked Data Science Lab; the profile and awareness of what we do is certainly growing.

What kind of data has been used to track Coronavirus’ impact in Wales?

The Datastore now contains or references antigen and antibody testing data, a consolidated mortality data view, hospital and ICU activity capacity and occupancy data, GP Out of Hours data, GP contacts,

recording and escalation rate, prescribing data, daily Emergency Department data, 111 calls data, Ambulance Incident data, symptom checker data, Modelling Scenarios data and COVID-19 reference and coding data – and vaccination data. Clients can access this via secure Data Warehouse views or, for aggregate data, using the Datahub.

Reflecting on this period, have you learned anything new about how data can be used?

Sourcing information from local ‘unstructured’ data sources alongside the centrally defined ‘structured’ datasets that we tend to rely on has been big for us. For example, we have used algorithms to analyse the Emergency Department data to identify patients presenting with severe respiratory or other COVID-19 symptoms. Challenging long established processes and demonstrating the art of the presumed possible has also been rewarding – for example, at the onset of the pandemic and following a request from Public Health Wales, we approached the Office for National Statistics and were successful in pressing for the weekly electronic flow of Welsh death notifications to be made available automatically on a daily basis.

How much has Wales-wide organisational collaboration contributed to the country's robust Coronavirus response?

It’s been a critical success factor. People have and are working silly hours, utilising any resources of utility at their disposal to help deliver solutions at pace and across organisational boundaries, united by a common sense of purpose and with refreshingly clear, simple mandates and minimal red tape. I’ve never known a time where we, Health Boards, Public Health, Welsh Government, Welsh Universities, local authorities, the Army, and the private sector have worked so well together.

Do you think the way the public interacts with governmental data has shifted this year?

The public’s appetite for clear and insightful data has clearly never been greater, but so many have been drawn to misinformation on social media. Welsh Government, Public Health Wales and others we support have had the tricky job of both publishing the stats and addressing the demand for more transparent sharing of information, especially so the epidemiological, modelling and other evidence used to inform decisions that have impacted painfully on all of us. It’s been interesting to compare the different approaches taken by the home countries. For England and No 10, ‘next slide please’ became a popular and sometimes teasing meme, perfectly capturing the zeitgeist as scientific advisors and ministers took it turns to bombard the public with PowerPoint slides packed with data and visuals, not always of the highest clarity. Wales and Scotland seem to have taken a less autocratic line. Ministers talk more in terms of insights offered by specific figures and encourage use of web-based resources. The public also ask some pretty good questions of the data!

What’s next for you and NHS Wales in 2021?

There’s a longlist! Finishing off the work to support vaccination roll-out, analysing the impact of the pandemic on ‘essential services’, moving the vast amount of data now available in the Datastore and Datahub into the emerging National Data Resource, working with our academic partners to address key post-COVID research questions and outcome studies, taking forward our data science ‘Advanced Analytics’ agenda, ensuring we deliver on day job commitments as detailed in our ambitious three year Integrated Medium Term Plan – but perhaps most importantly of all, preparing to become a new statutory organisation and special health authority called Digital Health and Care Wales.