PrescQIPP

South-West London’s (SWL's) pioneering and holistic digital strategy to generate real-world data from high cost drugs data platform to optimise patient outcomes (2025)

South-West London Integrated Care Board

Project summary

SWL has revolutionised its high cost drug (HCD) processes shifting the focus to pro-active stewardship aiming to “do things right first time for patients”. SWL can digitally conduct patient outcome-based audits, enhancing our ability to identify unwarranted variation and gather real world outcome data to improve patient care.

Following a strategic multidisciplinary and multi-organisational review in 2022, we aimed to enhance data processing and reporting functionality to ensure consistent selection of the most clinically appropriate and cost-effective HCDs for patients, in line with NICE Technology Appraisals (TAs) and local pathway agreements while achieving clinical outcomes.

Following governance approval, a steering group led a digital transformation program to automate and simplify data entry forms, while improving data extraction and analysis functionality. Functionality was leveraged to validate 80-90% of data entry, reducing manual processing, calculations and repeated data entry. As requested by hospital Trusts, the focus shifted to the front end of the process with Trust pharmacy teams collaborating with clinical teams to ensure internal compliance with NICE and pathway agreements. The improved system supports clinical pharmacists by significantly reducing clinical prescription screening time.

The system, now used as a notification system (not prior approval), serves as a system-wide clinical audit and benchmark tool to review pathway implementation, identify practice variation and highlight areas for improvement and generates real world data, particularly where evidence is lacking (e.g. sequential use of HCD).

It also supports the SWL virtual multi-Trust MDT process for patients who experienced primary or secondary failure to three prior HCD therapies. This peer-review process, valued by clinicians, is in place for rheumatology, dermatology, most recently gastroenterology and will potentially expand to other disease areas. Patient outcomes are tracked and reported to the SWL Integrated Medicines Optimisation Committee every six months, creating a repository of real world outcome data for sequential drug therapy.

Audits conducted thus far showed:

  • Increased use of first choice treatment options in rheumatoid arthritis (now 80-90%).
  • Migraine practice variation, prompting a review with hospital clinicians.
  • Limited benefit from vedolizumab dose escalation resulting in an adjustment in vedolizumab dose escalation pathway.
  • Overlap in anti-VEGF injection frequency and good response to ranibizumab biosimilar in 60% of patients.

The next stage involves working with our local business intelligence team to link HCD data with hospital and primary care data. This will help assess the impact of HCD use on e.g. hospital attendances and identify potential health inequalities.

This data-driven digital project leverages real-world data, clinical collaboration, automation to standardise prescribing practices, optimise medicine value while enhancing patient health outcomes, demonstrating how digital tools can support medicines optimisation and learning health systems.