supplier forum update on the secondary uses service jeremy thorp april 2008
TRANSCRIPT
Supplier Forum
Update on the Secondary Uses Service
Jeremy Thorp
April 2008
What are “secondary” uses ?
A considerable amount of information is collected during the provision of care and supporting services
The primary purpose of this information is to support and improve individual patient care
However, this information is of value for many other purposes to support healthcare and providing appropriate steps are taken to meet confidentiality obligations, this information can legitimately be used to support these other purposes.
These are called “secondary uses”
[amended from CRDB Secondary Uses Report, August 2007]
Care Record Service(CRS)
Reportng Service(SUS)
NHS Choices
Information available at the point of care Health record
securely accessible to
patients
Personalised wellness support
for patients &
public
Public access to quality
information
clinical improvement
NHS business processes
staff information
How does it all fit together ?
Identifiable Pseudonymised or Anonymised
•Individual records•Selected “lists” of
•records•Immediate access
•Dynamic, up to date•Workflow, rules based
•alerts
• Frequent abstracts•Focus on classes
of persons •Time series
•Short time intervals•Prospective indicators
•Focus on classesof persons
•Actual compared withexpected
(inputs, outcomes)• Ongoing
• Indicators
•Focus on classes or •cohorts
of persons• Disease, Service and
populationbased
• Forecasting•Periodic
OperationalDirect Care
Commissioning Analysis / Service Planning
BusinessOperations
Strategic /Policy / Research
Examples of characteristics of requirements
Primary and SecondaryUses
Objectives of the Secondary Uses Service
To improve access to data to support the business requirements of the NHS and its stakeholders
To provide a range of software tools and functionality which enable users to analyse report and present this data
To be the single, authoritative and comprehensive source of high quality data To enable linkage of data across all care settings To ensure the consistent derivation of data items and construction
of indicators for analysis To improve the timeliness of data for analysis purposes
To provide a secure environment which enables patient confidentiality to be maintained according to national standards
National (NASP) Contract
• Replacement of NWCS, including the receipt, validation and transfer of commissioning datasets to support– Commissioning– Payment by results– 18-week monitoring
• Receipt, storage and provision of access to Spine data– Demographics– Prescriptions– “PSIS” Summary Care Record
Release 3L providing “landing” capability for cds v6, plus loads from demographics and Choose and Book referrals – completed
Changes to support Payment by Results in 08/09 – completed
Release 3R providing processing & reporting for 18 weeks and further reporting for CAB and PDS – May/Jun 2008
Release 4 including further 18 week processing, pseudonymisation and cds upgrade – Oct/Nov 2008
Release 5, possibly to include PbR / HRG v4 – March 2009
SUS Releases in 2007 and 2008
NHS Comparator releases (Apr & Sept) - completed Early reporting of comparative referral to treatment waiting
times and elective pathways – completed Additional comparators and presentation of practice level
data, with particular emphasis on support for practice based commissioning resource allocation and budget setting; provider comparators – completed
Data quality dashboard - initial release completed Extended range of comparators and refresh underlying
data, including dispensed prescriptions (Detailed content to be agreed with DH and NHS users) – due Apr 08
SUS Releases in 2007 and 2008
• 18+ Terabytes of data in SUS
• > £30 billion of PbR transactions processed
• 800+ million Activity records submitted to SUS
• Over 1 million records entering SUS each day
• Over 100,000 managed service extract reports produced from SUS
• Over 20,000 user-defined extracts produced
• Over 4,500 users registered for NHS Comparators
• Over 1,500 users registered for SUS
• Currently over 320 organisations submitting data
Some Statistics
Local Service Providers
• Functionality to
– produce mandatory datasets (e.g. CDS)
– enable users to select and extract data from reference solution (all elements of a patient’s record)
– manage / store these extracts and combine them (linkage) with other data
– enable analysis and reporting of these data, including geographical analysis and presentation
– Provide users with access to other specialist analysis tools (e.g. SPSS)
• Production of standard reports (scheduled and ad hoc)
• Need to consider the use of business intelligence in a wider secondary uses context:– Reporting through other national bodies
• Information Centre (HES, NHS Comparators)• Healthcare Commission
– Research and Development:• Databases such as GPRD, Biobank
– Public Health• Public Health Observatories• Cancer Intelligence Centres
– Reporting through Local Service Providers– Local Reporting Solutions
Reporting is at all levels ….
• there should be one national approach to secondary uses
• user access would be managed through the security and confidentiality facilities within NHS CRS
• information provided through the Secondary Uses Service will normally be pseudonymised
• data would, where possible, be collected or derived from clinical systems as a by-product of direct care
• SUS would include the tools and services for an effective and secure working environment for analysis and reporting
Which implies ….
SUS Information Governance Strategy
Security - includingPhysical security, access control, audit, archive
Confidentiality - includingPseudonymisation regime, dissent, etc
Data Quality
Education & Training - includingEnsuring well trained users understand IG rules
IG Toolkit
Last Updated: Tuesday, 20 November 2007, 19:51 GMT
UK's families put on fraud alert Two computer discs holding the personal details of all families in the UK with a child under 16 have gone missing. The Child Benefit data on them includes name, address, date of birth, National Insurance number and, where relevant, bank details of 25 million people. The chancellor urged people to monitor their bank accounts
Is this important ?
Extract Service
Aims of the Extract Service
• To enable wider access to SUS data and hence to encourage greater use of the information
• To provide the data in a safe and secure manner that protects the confidentiality of individual patients
CDS Types
• Admitted Patient Care (APC) Finished Episodes• Out Patients (OP)• Accident & Emergency (A&E)
• Full data sets with pseudonymisation and derivations• New specific format• CDS developments - as new CDS versions are
introduced, changes will be made to the content and format to reflect the changed data items
Format/Content
• Patient - demographics• Admissions• Discharges• Episodes and Spells• Clinical• Health Resource Groups
• Organisation• Geographical• Practitioner• Augmented/critical care• Maternity
Pseudonymisation - 1
• Removed fields– Name & address– Record identifiers– Ethnicity
• Pseudonymised Fields– NHS Number– Local Patient Identifier– Date of Birth– Postcode– Consultant Code– GP Code
Pseudonymisation - 2
• Derived fields– Age eg start/end of episode, Mother (from d.o.b.)– Year of birth, year and month of birth of Mother– Organisations eg Practice, PCT, SHA (from
Postcode)– Duration of stay (from start & end dates)– Areas eg electoral ward, provider location, census
output area, country, county, ED District, government office, Local Authority (from postcodes)
File Sizes
• File size estimates – a rolling 3 months national extracts– APC Episodes - 4 million rows by 253 columns
• 375 megabytes compressed • 3 gigabytes uncompressed
– Outpatients -16 millions rows by 112 columns• 1.2 gigabytes compressed• 7.5 gigabytes compressed
– A&E - 3 million rows by 85 columns• 270 megabytes compressed• 2.7 gigabytes uncompressed
Out of Scope
• Future outpatients• Mental health• Payment by Results• Other derivations, such as Mosaic, meteorological
data• Comparison with HES On-line
Delivery Mechanism
• Via N3 End Point Registration • (visit www.n3.nhs.uk for more information)
• Via External Data Transfer (EDT) Client software installation which supports inbound communications
Commercial Basis
• Charges are based on the recovery of costs incurred• The contract for SUS is between NHS Connecting for
Health and BT• The Service Description becomes an agreement
between the applicant and the Secretary of State for Health
• The service levels are as defined in the BT NASP contract
• NHS Connecting for Health and BT agree specific details of dates and deliveries in consultation with the applicant
• BT bill NHS Connecting for Health, and NHS Connecting for Health bill the applicant directly
