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Supplier Forum Update on the Secondary Uses Service

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

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Supplier Forum Update on the Secondary Uses Service

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  1. Supplier ForumUpdate on the Secondary Uses Service Jeremy Thorp April 2008

  2. 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]

  3. How does it all fit together ? Information available at the point of care Health record securely accessible to patients Care Record Service (CRS) clinical improvement Personalised wellness support for patients & public NHS Choices Reportng Service (SUS) NHS business processes Public access to quality information staff information

  4. Identifiable Pseudonymised or Anonymised Primary and SecondaryUses Business Operations Commissioning Analysis / Service Planning Operational Direct Care Strategic / Policy / Research Examples of characteristics of requirements • 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 classes • of persons • Actual compared with • expected • (inputs, outcomes) • Ongoing • Indicators • Focus on classes or • cohorts • of persons • Disease, Service and • population • based • Forecasting • Periodic

  5. 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

  6. 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

  7. SUS Releases in 2007 and 2008 • 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

  8. 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

  9. Some Statistics • 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

  10. 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)

  11. Reporting is at all levels …. • 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

  12. Which implies …. • 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

  13. SUS Information Governance Strategy • Security - including • Physical security, access control, audit, archive • Confidentiality - including • Pseudonymisation regime, dissent, etc • Data Quality • Education & Training - including • Ensuring well trained users understand IG rules • IG Toolkit

  14. Is this important ? Last Updated: Tuesday, 20 November 2007, 19:51 GMT

  15. Extract Service

  16. 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

  17. 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

  18. Patient - demographics Admissions Discharges Episodes and Spells Clinical Health Resource Groups Organisation Geographical Practitioner Augmented/critical care Maternity Format/Content

  19. Pseudonymisation - 1 • Removed fields • Name & address • Record identifiers • Ethnicity • Pseudonymised Fields • NHS Number • Local Patient Identifier • Date of Birth • Postcode • Consultant Code • GP Code

  20. 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)

  21. 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

  22. Out of Scope • Future outpatients • Mental health • Payment by Results • Other derivations, such as Mosaic, meteorological data • Comparison with HES On-line

  23. 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

  24. 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

  25. If you want to find out more ….. • Contact jeremy.thorp@nhs.net

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