Development of a 'Case-Finding' Database to identify individuals at risk of liver and metabolic disease within the Somerset Liver Improvement Programme

Background: 10% of the population have abnormalities on liver blood tests. Accurate diagnosis of clinically significant abnormalities is difficult due to the lack of symptoms, difficulty in interpreting liver tests, unclear referral pathways and absence of effective screening programmes. 50% are diagnosed as emergencies with complications; and chronic liver disease accounts for >100,000 lost years of life per annum in England and Wales. Preliminary work in Somerset has shown that patients with potential liver disease can be diagnosed earlier by analysis of pre-existing laboratory datasets - case-finding approach. However, the existing tools used to analyse these data are too complex for use in clinical practice at scale. Objectives: The aim of this innovation project will be to develop a computer system that will enable rapid, clinician-based analysis of laboratory data to identify patients with a high likelihood of undiagnosed liver disease. Patients can then be recalled for testing and treatment as required. The system will be scalable, will interface with all standard laboratory systems, and use pseudonymised data with re-identification only within patients own healthcare system. The intention is to deliver a solution usable across the NHS. Project plan: The system will use CareXML to extract and hold data in a Common Data Model. Adaptors will be created to import data from key NHS systems. An Analysis Tool will be developed using an Agile development approach. Clinical input will enable iterative development and testing of analytical algorithms. Through continuous patient and public involvement, and engagement with the wider NHS, the team will ensure delivery of a powerful case-finding tool for liver disease. Impact: A usable system should be available within 18-24 months, followed by testing and marketing to the NHS. Estimates of cost-effectiveness suggest a potential 10-fold return on total investment for every 1% improvement in effectiveness of liver services.