John Hopkins Whitepaper: Bridging the Hospital to Community Shift
Examining the shift towards neighbourhood-based care and prevention
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We are a British shared care record, population health and healthcare analytics company founded in 1994. Our systems hold cradle to grave medical records for 17m citizens, combining detailed hospital, GP, community, mental health, urgent care and social care data into a single record.

Combined Intelligence for Population Health Action or CIPHA is a population health data solution which combines analytics and population health insights, workflow, shared care records, patient access, data collection and remote patient monitoring into a single end to end solution. This allows insights to be converted to actions and for outcomes to be monitored in real time so that success can be measured.

27 November 2024
Using data from the Graphnet Shared Care record to support timely decision making for the safety of at-risk adults
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06 September 2024
How a heart failure virtual ward is supporting patients to receive the care and treatment they need at home and reducing their need for visits to hospital.
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21 May 2024
Frimley outline how segmenting patients using Johns Hopkins scoring alongside population health has improved outcomes.
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28 February 2024
Looking at how patients with medical conditions made worse by the cold were identified and supported with Cheshire & Mersey's fuel poverty programme.
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24 November 2023
Examining the positive outcomes of proactively addressing health inequalities in pregnant women. Cheshire & Merseyside is using data to target those most in need of support and guidance by using a multi disciplinary approach.
Read more17 July 2025
27 May 2025
04 April 2025
With more than 30 years of industry experience, our healthcare data solutions are helping to revolutionise patient care by addressing key challenges in delivery.
Cheshire and Merseyside: used population health to identify more than 1,300 people at risk of developing serious health issues due to fuel poverty.
Firmley: identified patients suitable for remote monitoring. Over the past year, this has led to 40% reduction in hospital admissions for high need patients and 34% for care home residents.
Buckinghamshire Healthcare NHS Trust: combines surgical waiting lists with the Shared Care Record. 20% of patients do not require pre-op assessment.