Healthcare Management2018-07-10T14:21:53+00:00

Population health management

A simple and innovative approach to population health management. Collect healthcare data for every patient. Analyse information in a cloud-based dashboard. Share pathways and data entry templates with GPs to influence change.

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Outcomes Manager


Daily extractions from all major GP clinical systems for responsive, up-to-the-minute central reporting.


Cloud-based reporting dashboard enables centralised analysis of any aspect of your population’s healthcare service provision including:

  • Case finding
  • Disease management
  • Service re-design

Influence change

Create standard data-entry templates and deploy them to all clinicians to ensure compliance with local policies.


Works with all major GP systems

Collect data from all major GP IT systems including Vision, EMIS and SystmOne. Use centralised cloud-based reporting without changing a single GP practice system.

Anonymised data for light information governance

Extract detailed statistics about patients’ healthcare instead of entire patient records. Less data moves about and information governance requirements are very low.

Data is available immediately

  • Extract data as often as you want
  • Reports are available within 24 hours
  • Request historical data for monthly or annual comparison
  • Automated extractions so there is no need for manual intervention at GP practices
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Centralised cloud-based dashboard. View data from any number of GP practices.

  • Identify specific cohorts of patients that are relevant to local healthcare challenges
  • Flexible interactive reporting
  • Drill down into increasing levels of detail
  • Compare to historic data

Typical uses:

  • Case finding
  • Disease management
  • Local service payment calculations
  • NHS Health Checks
  • Service redesign
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Influence change

Guide behaviour change. Suggest diagnoses and appropriate treatment options without overpowering a GP’s judgement.

  • Highlight patients that each practice should review
  • Warn GPs during consultations when the patient needs a review
  • GP alerts display alongside QOF reminders to avoid alert fatigue
  • Improve awareness of your local heathcare policies and compliance with preferred pathways
  • Minimal training required
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Population health management in action at NHS Greenwich CCG

Outcomes Manager enabled NHS Greenwich CCG to effortlessly identify an additional 4,000 patients with long term conditions, reducing health inequalities and increasing life expectancy in the borough.

I was really impressed with how up-to-date data from all of our 39 practices across the borough was available for me to review in one central dashboard enabling me to track progress on the identification and review of patients with long term conditions and ensuring accurate service payments were made.

Jan Matthews, Director of Commissioning at NHS Greenwich CCG

Click to download Greenwich CCG case study

Smarter, faster and better DMARDs management

Practices typically manage their DMARDs by combining multiple searches with paper-based records and Excel lists, a cumbersome and inefficient process. DMARDs Manager lets them work smarter, faster and better.

Work smarter

  • See which patients are taking drugs such as methotrexate but not claiming
  • No need to populate several different systems
  • More efficient calls/recalls

Work faster

  • List patients who have blood tests due or overdue
  • Intelligent prompts to tell your phlebotomists which blood tests should be taken

Better patient care

  • Reduce the risk of adverse drug reactions
  • Identify patients sitting in a void between primary and secondary care
  • Make sure you recall the right patients at the right time
  • Highlight patients whose prescriptions for high risk drugs should be stopped

DMARDs Manager is available centrally-funded on GPSoC so there is no cost to GP practices in England.

Improve your DMARDs management

Identify patients at risk of cancer

Developed in collaboration with Macmillan Cancer Support

Know which patients are at risk of site specific cancers including:

  • lung cancer
  • colorectal cancer
  • oesophago-gastric cancer
  • pancreatic cancer
  • ovarian cancer

Decision support

Vision’s cancer decision support is based on Professor Willie Hamilton’s Risk Assessment Tool. It helps GPs to think cancer and raises awareness of cancer signs and symptoms. It also provides a patient safety net and aids continuity of care in practices where a patient may see many GPs.

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Manage and control chronic kidney disease

Kidney Research UK has reported some alarming statistics about chronic kidney disease (CKD):

  • between 2005 and 2015 there was a 31.7% global increase in the number of people dying from CKD
  • the burden of the disease increased by 19.6%
  • estimates suggest that three million lives are at risk from CKD. As many as one million of these cases are undiagnosed

An early diagnosis helps GPs to manage and control CKD cases.

CKD Manager helps GPs to:

  1. Diagnose CKD earlier
  2. Avoid unnecessary renal decline
  3. Reduce the number of people dying early from CKD

CKD Manager is available centrally-funded on GPSoC so there is no cost to GP practices in England.

Get started with CKD Manager

Intelligent INR management

Interactive clinical pathway

  • Integrates with consultation workflows
  • Calculate recommended weekly anticoagulant doses in accordance with NICE guidelines using existing clinical data
  • Divide doses equally across the week or vary for each day to match available medicine strengths
  • Print clear and simple daily dosage instructions for patients

Decision support

  • Side effects
  • Hospital episodes
  • Links to information about national and local enhanced services


  • Flexible and detailed reports on any aspect of a GP practice’s anticoagulation register

Can be used by an individual GP practice or deployed across all practices in a CCG or health board area.

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The NHS is changing. Be ready.

Our innovative solutions encourage collaborative working and shared care. Designed with the new models of care in mind, they meet the demands of a modern NHS.

Mobile working

Mobile working

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Interoperable shared patient records

Shared care

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Shared care

Online patient services

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Introduction to Population Level Healthcare Management

The emphasis on QOF continues to decline. Healthcare service providers must analyse data across their population to address local challenges. This is possible without asking busy GP practices to extract data themselves.

Our guide describes everything you need to know to get started with population-level healthcare management.

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Population level healthcare management