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Piecing Together the Future

Empowering the GP practices to submit standardised data for

Enhanced Services

Lesley Bruce

Informatics Advisor

Middlesbrough PCT

12th May 2005

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From this:

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To this:

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Middlesbrough PCT

• Population of 190,000 (approx)

• 30 GP practices– 14 System 6000– 6 Synergy – 1 Emis GV – 2 Emis PCS– 6 Emis LV– 1 Vision

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Enhanced services – progress to date• Rheumatology• Anti-Coagulation including DVT Proven and DVT

Screening• Minor Surgery• Influenza vaccinations• To be added• IUCD fits and checks

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Rheumatology Monitoring

• Annual audit for DMARDS in Aug/Sept 2004 for 32 practices

• Patients on DMARDS for Rheumatoid Arthritis were identified

• List to practices to code patients with 66H.. – Rheumatoid Arthritis Monitoring

• Any subsequent new patients to be coded with 66H..

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Rheumatology data collection• Search criteria

– All patients coded with 66H..– All patients coded with 66H with an issue of a DMARD

in the previous 6 months

Data is imported in to the Access database and then exported in to Excel for electronic submission

Result = No of patients monitored in the previous quarter – data is submitted electronically to the PCT

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Anti-coagulation Monitoring• System 6000/Synergy – using Report Manager

– List of patients with an Authorisation of Warfarin (include start date in the search results)

– List of patients with an Issue of Warfarin in the previous six months

Data is imported in Access, manipulated to match patients, then exported to Excel for Electronic submission

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Calculation Process (at the PCT)• Filter on patients with an Authorisation and

an Issue.– If Authorisation date <Quarter start date then

no. of days monitored = full quarter eg 91 days– If Authorisation date >Quarter start date then

calculate days difference between Authorisation Start Date and quarter end date = no of days monitored

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Warfarin Monitoring - Emis users

• The principles are the same as for System 6000/Synergy but requires the following additional information– Warfarin Monitoring Started - 66QS. (built into

to the search criteria). This is used in place of Authorisation Start Date.

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Minor Surgery• Search in clinical system uses Read Code 987%

during the previous quarter• Data is imported into Access then exported out to

Excel for electronic submission

• Calculation process at the PCT - Filter on:– 9877 – injections– 9879 – incisions– 987A – excisions

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What are the Benefits:

• Searches in the GP practices are standardised – only input required is to enter the current date parameters

• The import and export process using Access is automated – no intervention by the practice is required

• The Excel output is a standard data set with standard headings

• The practice code and subject of the data is preset in the name of the Excel file

• The data can be submitted on time and a back up copy is held on the practice system

• It is easy to use!! And works on all the clinical systems!!!

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Comments from Practices

• “The guidance notes are very easy to follow. It took longer to run the reports than it did to compile and send data, about 5/10 min's for the longer reports from compiling data and attaching it to e-mail.  The only thing you have to think about is the dates.”

(IT manager – System 6000)

I have just forwarded the Quarter 4 enhanced services report for your perusal.

Doing the reports in this format has made the workload much easier and also given me the confidence to know that the information sent to you is accurate.

Thank you again for your help.(Administrator – System 6000)

I found the enhanced services database straightforward to use once shown, its just a matter of remembering to change the dates each time for that specific quarter.  I’m sure next time when I come to running the searches there will not be any problems.

(Administrator – Emis LV)

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More comments:

Please find attached Q4 figures. With regards to the enhanced Access database you have set up on our system, I personally find this very simple to use. It holds the data in a central location and cross references certain data instead of us having to do it manually.

(Administrator – Emis GV)

The database is very easy to use (when I get the dates correct!). It took me about 25 mins to run it all and attach the files to e-mail.

(Adminstrator – System 6000)

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THE BIG ONE!!!THE BIG ONE!!!Flu data

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FLU Vaccination data – Under 65’s at risk

• How to compile the register

• How to split into age groups and disease registers

• How practices can retrieve the data to enter on to the DOH database (mandatory from 2005)

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Where to start:

• Start July/August

• Use the clinical reporting system to retrieve the patient lists

• Analyse the data in Access to provide a list that counts the patient once, even with multiple diagnoses

• The practice then need to validate the register and agree numbers

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Split by Age and Disease

• Using Excel filter on age groups and add a column assigning Box 1,2,3,4,5 respectively

• Apply a hierarchy to determine Disease register– Box 1 – COPD/Asthma– Box 2 – CHD– Box 3 – Diabetes– Box 4 – All other

Add a column assigning Box 1,2,3,4 resepctively

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Patient ID DOB COPD Asthma IHDRenal

Disease Diabetes

Immuno suppress

edAge

RegisterDisease Register

1794 11/04/1951 Y Box 5 Box 11787 15/06/1957 Y Box 5 Box 44496 10/08/1982 Y Box 4 Box 1

15389 06/06/1964 Y Box 4 Box 31803 02/01/1953 Y Box 5 Box 3

13629 14/11/1958 Y Box 5 Box 213629 14/11/1958 Y Box 5 Box 21765 27/07/1979 Y Box 4 Box 15511 04/02/1959 Y Box 5 Box 2

5633490 01/01/1957 Y Box 5 Box 330 29/11/1962 Y Box 4 Box 4

5391463 10/03/1979 Y Box 4 Box 149 23/02/1941 Y Y Box 5 Box 1

1852 13/11/1945 Y Box 5 Box 28964 15/09/1960 Y Y Box 4 Box 23154 22/05/1951 Y Box 5 Box 31875 21/06/1955 Y Y Box 5 Box 21875 21/06/1955 Y Y Box 5 Box 21887 05/05/1944 Y Box 5 Box 31891 25/12/1972 Y Y Box 4 Box 15595 05/03/1944 Y Box 5 Box 35629 16/09/1957 Y Box 5 Box 2

16364 25/08/1959 Y Box 5 Box 21929 03/09/1952 Y Box 5 Box 31941 22/04/1964 Y Box 4 Box 31947 30/06/1942 Y Box 5 Box 25661 24/09/1955 Y Box 5 Box 29033 27/06/1947 Y Box 5 Box 1

3427288 01/01/1951 Y Box 5 Box 3

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How the practices retrieve the data!

• Use the search for Flu vaccination given, within the clinical system, with prompts for a date range to be entered

• They then run the Access program that• Retrieves the data from the clinical system• Matches the data against the register• Prints reports that groups the data into Age groups and then Disease

groups• Prints a report that identifies the patients left to vaccinate month on

month• Estimated time to complete 1min 30 secs 1min 30 secs • Remember this part is automated, requiring no intervention by Remember this part is automated, requiring no intervention by

the practicethe practice

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Any questions?

Contact details:

Lesley Bruce

Informatics Advisor

Lesley.bruce@middlesbroughpct.nhs.uk