At the height of the COVID-19 pandemic, NHS Digital, supported by BJSS and Oxford University, identified 1.7 million Clinically Extremely Vulnerable individuals to be added to the national shielded patient list and prioritised for vaccination. The NHS Digital and BJSS blended team made this possible by developing the COVID-19 Clinical Risk Assessment and Risk Stratification tools, which enabled millions of rows of demographic data to be fed through Oxford University’s QCovid® risk-prediction algorithm. 

Challenge

At the start of the pandemic, the risk factors of COVID-19 were fairly unknown. This, therefore, made it difficult for clinicians to identify those most at risk of dying from the disease.

Research commissioned by England’s Chief Medical Officer uncovered several risk factors that could increase the likelihood of death from COVID-19. Using this insight, the University of Oxford developed QCovid® – a COVID-19 risk-prediction model that is considered the first of its kind - to meet the highest standards of evidence and assurance.

With a cutting-edge risk-prediction model in place, NHS Digital and BJSS sought to create a data solution capable of processing millions of rows of NHS patient data* through QCovid®.

Solution

From the outset, NHS Digital and BJSS worked to understand the data solution’s use cases.  A Discovery exercise was carried out, resulting in the identification of three requirements:

• An online Clinical Risk Assessment tool allowing healthcare professionals to search for a patient’s risk of dying from COVID-19
• A Risk Stratification tool to process England’s entire population through QCovid®
• An online Population Risk Assessment Viewer allowing GPs to view their patients QCovid® risk assessment outcomes securely.

To create the Clinical Risk Assessment tool, the combined BJSS and NHS Digital team developed an AWS platform and online tool that interacts with the QCovid® risk calculator through a secure set of APIs. When clinicians input patient data into the tool, the APIs run the information through the algorithm to provide an individual’s COVID-19 risk. The tool’s front-end follows NHS Digital’s style guidelines, providing clinicians with a familiar and intuitive user experience.

BJSS and NHS Digital were then tasked with running England’s entire adult population (aged 19-100) through QCovid®. To achieve this, the team processed 46 million lines of patient data using NHS Digital’s Databricks platform. The data was filtered down using a minimisation process, removing people with no recorded high-risk factors. Approximately 15.5 million people were identified to be processed through QCovid®, culminating in an additional 1.7 million individuals being added to the shielding list. These individuals were yet to be selected for vaccination and were therefore urgently prioritised by their local GPs.

Furthermore, BJSS and NHS Digital developed a secure online web viewer to allow GPs to view details of the 15.5 million patients who were processed through QCovid®. This data set contained patients who had some risk factors but were not considered to be Clinically Extremely Vulnerable. These patients were therefore not added to the Shielded Patients List. This secure online portal solution was delivered in just four weeks, utilising NHS Mail for multi-factor authentication, a DynamoDB authorisation solution, NHS Digital Databricks, AWS S3 buckets and Nextjs server-side pages.

The resulting solutions are classed as medical devices and have successfully received UKCA certifications.

“I just wanted to take a moment to reflect on everything we have achieved and say a heartfelt thank you for the incredible hard work that has been done by the whole team over recent weeks and months. Every single person has remained positive, focussed and good-humoured, and together we have achieved great things. It’s an absolute pleasure to work with every single member of the team, and there is, of course, more to come!”

Jonathan Benger, Interim Chief Medical Officer, NHS Digital

Benefits

Delivered in just seven months
In just seven months, the combined NHS Digital and BJSS team delivered and launched three critical solutions that have played a significant role in the health service’s battle against COVID-19. This was achieved using agile ways of working and focusing on collaboration, despite operating as a geographically dispersed remote team. The commitment and approach taken by BJSS and NHS Digital ensured the rapid delivery of these vital tools during a time of urgent need.

1.7 million patients prioritised for the vaccine
Since its launch, the Clinical Risk Assessment and Risk Stratification tools have had a significant impact on protecting those most at risk of dying from COVID-19. Over 4,900 clinical risk assessments were conducted at launch, giving healthcare professionals an instant view of a patient’s COVID-19 risk during a consultation. The Risk Stratification tool has made it possible to run vast amounts of patient data through QCovid®, making it easier for the NHS to identify those most at risk of dying from COVID-19. Crucially, it has helped to prioritise an additional 1.7 million Clinically Extremely Vulnerable patients for the vaccine.

Democratising data within the NHS
The launch of these data platforms is a revolutionary step forward for the NHS. It is analysing vast amounts of patient data for the first time and feeding it through to a third-party algorithm such as QCovid®. Clinicians have access to the data and insights they need to provide better patient outcomes. But most importantly, vulnerable citizens in the UK can be safe knowing that they will receive the care and support they need.

*BJSS did not store or access any NHS patient data throughout this delivery.

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