TPP is proud to have collaborated in pioneering research into factors linked with COVID-19 hospital deaths in the UK. Working in conjunction with leading academics from Oxford University and the London School of Hygiene and Tropical Medicine (LSHTM), on behalf of NHS England and NHSX, TPP has utilised its integrated system of electronic health records, allowing researchers to study pseudonymised data from a database of 24 million electronic health records (EHRs). In this initial study, researchers have used data from 17 million patients, in what is the largest study of its kind. The newly-created analytics platform, known as OpenSAFELY, has allowed clinicians to identify key risk factors. The research has found that age, gender, as well as conditions such as diabetes and asthma, all serve to increase the risk to patients from COVID-19.
The project is spearheaded by leading UK physician Dr Ben Goldacre, alongside Professor Liam Smeeth, an epidemiologist at LSHTM. It has been enabled by the UK government’s control of patient information (COPI) notices for COVID-19 outbreak, which allow for a wider use of patient data in response to the crisis. OpenSAFELY, which is a collaboration of epidemiologists, developers and data scientists, provides academic and technical expertise to study the 24 million linked health records. A project of this scale could be expected to take months or years to realise, but the collaborative effort has meant that OpenSAFELY took only 42 days from drawing board to first publication.
In order to deliver a high-security, safe research platform at scale, the OpenSAFELY approach does not involve moving or replicating the electronic health records for millions of people. Instead, the data remains in-situ. Researchers access only the data they need to perform their analyses and no data is ever removed or exported. This method, which was developed by TPP’s developers and the engineers at Goldacre’s EMBDataLab in Oxford, has attracted praise from medConfidential, an organisation which focuses on patient confidentiality. Dr John Chisholm, who chairs the Ethics Committee of the British Medical Association, told The Economist that the study contains “hugely valuable information about risk factors from COVID-19”, in a clear indication of the value of the research, as well as its credentials in the field of medical ethics. TPP have committed significant resource to the research; it has received no funding for the work and will continue to work pro-bono throughout future OpenSAFELY COVID studies.
The research is powered by UK NHS primary care data that, almost uniquely, contains a patient’s comprehensive medical history across care settings. Many countries have more fragmented systems than the UK, often holding data in silos, making patient journeys almost impossible to track. The UK also has a relatively large, diverse population, giving the research a unique insight into the impact of the virus across a wide range of demographics.
The first research paper utilising OpenSAFELY consulted 17 million medical records, and investigated factors associated with COVID-19 hospital deaths in the UK. Coverage of these first research outputs has been extensive, with BBC News reporting the paper’s finding that risk is doubled for those patients classified as obese. American broadcaster CBS News has discussed the implications of the study for our understanding of how COVID-19 impacts ethnic minorities, with the research indicating that black people in England and Wales are four times more likely to die from the virus than their white counterparts. Further coverage has focused on the implications of OpenSAFELY for the study of medical records more generally, with the Economist reporting on the rapid nature of the study pertaining to the urgent circumstances researchers are confronted with.
Research projects like OpenSAFELY highlight the power of EHRs in medical research. While initial research has focused on factors associated with death from COVID-19, the group have now moved on to engage in further COVID studies. For example, the researchers are now examining the impact of drug exposures, including inhaled corticosteroids and ACE inhibitors, as well as the effects of COVID-19 on children. TPP’s Research Director Dr Chris Bates describes the “incredible collaboration” achieved through the study, stating that enormous ground has been covered in only a matter of weeks. He added “COVID-19 has forced us to act quickly, safely, securely. This is a research paradigm that we hope will continue for all electronic health research into the future.”