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Opportunities and Challenges of SUS. Roger Dewhurst Director of Operations, Information Centre for health and social care. What are “secondary” uses ?. A considerable amount of information is collected during the provision of care and supporting services

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opportunities and challenges of sus
Opportunities and Challenges of SUS

Roger Dewhurst

Director of Operations, Information Centre for health and social care

what are secondary uses
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]

primary and secondary uses

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
objectives of sus
Objectives of SUS
  • Improve access to data to support the business requirements of the NHS and its stakeholders
  • Provide a range of software tools and functionality which enable users to analyse report and present this data
  • Be the single, authoritative and comprehensive source of high quality data to
    • enable linkage of data across all care settings
    • ensure the consistent derivation of data items and construction of indicators for analysis
    • improve the timeliness of data for analysis purposes
  • Provide a secure environment which enables patient confidentiality to be maintained according to national standards
what is sus
What is SUS?
  • A single repository of person and care event level data relating to the NHS care of patients.
    • Data is submitted by all organisations providing NHS care
  • At present SUS receives data submissions (CDS) relating to:
    • Accident and emergency attendances
    • Outpatient attendances
    • Admitted patient care, including maternity care
    • Elective admission waiting lists
    • Mental health care “spells”
  • In 2007/8 SUS will also receive data from Choose and Book and the Patient Demographics Service, as well as new CDS relating to future appointments and diagnostic events
  • In future SUS may receive data relating to patients’ prescriptions and may have the capability of managing data relating to the primary and social care provided to patients and service users.
what is sus1
What is SUS?
  • SUS comprises:
    • A common and consistent information governance model
      • Access control
      • Use of pseudonyms to replace identifiers
      • Design (e.g. small number suppression etc.)
    • A core data warehouse and data marts
    • Consistent metadata and reference data
    • Associated applications utilising data from the core warehouse
    • Consistent analysis and reporting tools
current sus components
Current SUS Components

Security and confidentiality ensured by consistent access control and design

NHS

Comparators

Landing

Staging

Web based

application for

Practices, PCTs,

SHAs

Universal Data

Warehouse

HES

A Core Warehouse and Data Marts

Data submitted by

all providers of

NHS “acute” and

Mental Health Care

HES reports and

extracts

PBR

NHS CDS

Extract

Other

Extract

Clinical

Audit

Consistent metadata – business and technical

Extracts for Non NHS

organisations

Extracts and Reports to all PCTs, Trusts, SHAs

what has been achieved
What has been achieved?
  • First release in 2005, with core NWCS and PbR functionality but suffered from:
    • Poor performance
    • Difficulties with interchange catch-up
  • SUS “get well” programme of work
  • PbR 06/07 delivered in March 2006
  • Decommissioning of NWCS required focus on Release 2006-B-1 in November 2006
  • Further defects and issues some of which still need to be addressed
  • BUT … SUS is still dependent on NHS organisations for timeliness and quality of data
slide9

SUS Releases in 2007/8

  • Release 1 for PBR 07/08 and data for PBC comparators (April 2007) – completed
  • Release 2 giving non-functional upgrade to Oracle 10g and uplift for more users – completed
  • Release 3L providing “landing” capability for cds v6, plus loads from PDS and Choose and Book (CAB)– December 07
  • Release 3R providing processing and reporting for 18 weeks and further reporting for CAB and PDS, includes changes necessary for PbR 2008/9 – April 08
slide10

SUS Releases in 2007/8

  • NHS Comparator releases (April and September) – completed
    • Early reporting of comparative referral to treatment waiting times and elective pathways – early January
    • Additional comparators and presentation of practice level data, with particular emphasis on support for practice based commissioning resource allocation and budget setting – end January
    • Extended range of comparators and refresh underlying data, including dispensed prescriptions (Detailed content to be agreed with DH and NHS users) – end March
  • Data quality dashboard - initial release December, subsequent releases during January –March, sponsored by the DH 18 week team
opportunities
Opportunities
  • A single secure data management environment provides an opportunity to reduce “transaction costs” of implementing systems reforms through:
    • Enabling access to data
    • Deriving essential data items consistently and once
    • Undertaking standard processing
opportunities1
Opportunities
  • A single secure data management environment provides the ability to construct consistent comparators and indicators
a framework for developing indicators for an nhs scorecard
A framework for developing indicators for an “NHS Scorecard”

Quality Indicators

Service

Outputs

Indicators relate to / cover:

“Population”

Needs

Identified

Population

Needs

Expressed

demand

for

services

“Population”

Outcomes

Service Activities

Service

Inputs

Demand

Indicators

Health Status Indicators

Effectiveness

Indicators

Indicators are constructed for:

Efficiency /

Productivity

Indicators

Populations

or groups

of patients

Providers

Services

Commissioners

data to construct indicators
Data to construct indicators

Quality Indicators

  • Operational data
  • person and activity specific
  • (e.g. CDS)
  • aggregated returns.
  • dispensed prescriptions
  • Population and target group
  • based surveys, including
  • Patient experience
  • Temporal analysis of outputs
  • subsequent revisions etc.

Service

Outputs

“Population”

Needs

Identified

Population

Needs

Expressed

demand

for

services

“Population”

Outcomes

Service Activities

Service

Inputs

Demand

Indicators

Health Status Indicators

Effectiveness

Indicators

Local and national “disease / disability

Registers” (within GP Clinical

Systems (QOF) etc., Cancer Registries)

provide identified

prevalence

Efficiency /

Productivity

Indicators

  • Population based surveys, which
  • are required to
  • establish unidentified need
  • calibrate local measures of
  • identified need
  • Operational data
  • included or implied in activity
  • specific (CDS)
  • Employee data from ESR
  • Financial returns and accounts
  • Operational data
  • person and activity specific
  • (e.g. CDS)
  • aggregated returns.
how sus might support indicator construction and presentation
How SUS might support indicator construction and presentation

Quality Indicators

  • SUS warehouse includes
  • operational data on outputs and their value /cost
  • NHS Comparators
  • includes indicators of quality of service, based on linkage of outputs
  • SUS functionality in 2008/9
  • could enable “longitudinal”
  • association of operational data
  • with survey population (s)

Service

Outputs

“Population”

Needs

Identified

Population

Needs

Expressed

demand

for

services

“Population”

Outcomes

Service Activities

Service

Inputs

Demand

Indicators

Health Status Indicators

Effectiveness

Indicators

  • NHS Comparators
  • uses data on identified need from QOF in
  • construction of indicators
  • Future releases will compare identified
  • prevalence and predicted prevalence
  • from population survey information

Efficiency /

Productivity

Indicators

  • Original SUS vision and NASP
  • contract scope includes
  • workforce data as well as (costed) activity data
  • could enable construction and
  • comparative analysis of efficiency
  • or productivity indicators
  • SUS 2008/9 releases
  • provide for capture and management of prescriptions issued
  • SUS warehouse includes
  • operational data on activities and expressed demand (e.g. CDS)
  • NHS Comparators
  • enables comparisons of demand indicators and quality indicators covering variation in
  • access to services
  • SUS functionality in 2008/9 to support
  • Cohort Management and PDS based linkage
  • could enable “longitudinal” association of
  • operational data with survey population (s)
  • PDS copy may allow construction of prevalence models as well as linkage
challenges
Challenges
  • Ensuring that the data currently submitted to and managed within SUS is:
    • Comprehensive
    • Timely (for different uses)
    • Consistent with agreed standards
    • Accurate
immediate data quality challenges
Immediate Data Quality Challenges
  • Improving the coverage of data
    • Missing data
    • Creation of duplicate records
  • Improving the content of individual records
    • Linkage of data
    • Correct access to and exchange of data
    • Correct financial payments
    • Correct comparators and indicators
    • Reduction in the unnecessary use of identifiable data
addressing data quality challenges
Addressing Data Quality Challenges
  • IC / CfH
    • Ensure improved functionality in SUS
      • Tracker
      • eDQRS
      • Data Deletions
    • Publish guidance and provide support
    • Publish data on quality and enable comparison
  • DH / SHAs
    • Performance manage organisations to improve quality
  • Regulators and Auditors
    • Audit and review data quality
  • Commissioners
    • Secure improvements through contract processes
  • Care Providers
    • Implement quality assurance programmes
immediate local implementation challenges
Immediate local implementation challenges
  • Achieving the migration to XML submissions
  • Improving the timeliness of data submissions
    • Migrating from the use of bulk protocols for data submission
context for more timely submissions
Context for moretimely submissions
  • Timely data to support achievement of 18 weeks target for referral to treatment
    • Linkage of activity into elective care pathways
      • Multiple providers within pathways
    • Prospective analysis and reporting
  • Ensure at least monthly submission of comprehensively coded CDS to support PbR
    • Mandate of SUS as authoritative source of information for payments
context
Context
  • Operating framework for 2008/9
    • Submission of finished activity within 5 working days of activity “finish” date
      • X % by July 2008
      • Y % by January 2009
    • Submission of completed (fully coded) data within 22 days of the activity “finish” date from April 2008
benefits
Benefits
  • Reduces processing time and complexity
    • 90% of records replaced in bulk updates are unchanged
      • Quicker access to data
      • Improved linkage
  • Reduces interchange rejection rates
  • Reduces the risks of duplicate records
challenges1
Challenges
  • Supporting NHS analysis requirements, while ensuring the security and confidentiality of identifiable data:
    • Meeting the Government’s commitment to minimise the use of such data for non-direct care purposes
information governance
Information Governance
  • Governance - develop & manage consistent, cohesive policies, processes and decision rights
  • NHS IG - ways & means of handling patient information in legal, secure, efficient & effective manner
  • Balance - sharing information and privacy
  • Impact - Encourage & enable improvements inquality and handling of information
context1
Context
  • Common law of confidence
  • Data Protection Act
  • DH Policy Guidance Confidentiality
  • Care Record Guarantee
    • This guarantee is our commitment that we will use records about you in ways that respect your rights and promote your health and wellbeing
  • Care Record Development Board
    • Secondary Uses Working Group
crdb principles for secondary uses
CRDB Principles forSecondary Uses

1.Default - use of data not linked back to individuals

  • Unidentifiable data (aggregate or anonymise)
  • Where linkage required - pseudonymise
  • If patient identifiable, informed consent if feasible

2. Patient right - to determine no identifiable information about them should be used for secondary purposes (legal exceptions)

  • Participation in research - approach through GP or relevant clinician
crdb principles for secondary uses1
CRDB Principles forSecondary Uses

3.Identifiable data is required, if consent not feasible, then formal justification for access is required

  • Section 60 H&SC Act 2001 (now S251 Health Consolidation Act 2006)
  • PIAG Approval may be granted if:
    • Benefit to patients
    • Not feasible to gain consent or use anonymous data

4. All users of data for secondary care purposes should be subject to enforceable standards regarding confidentiality and security of data

use of patient identifiable data
Use of patient identifiable data
  • Originating clinician – e.g. GP in their practice
  • Relevant clinician – e.g. GP in their practice
  • Section 60/251 approval from PIAG
  • Role allows – e.g. 18 weeks manager
  • Patient’s consent – e.g. research
  • Legal basis – e.g. court orders
implications
Implications
  • De facto use of pseudonymisation for patient record level data for secondary use
  • For PCTs - data for commissioning - pseudonymise
  • For Providers - analysis of performance,etc - pseudonymise
  • For practices - for practice based commissioning - pseudonymise
  • Where primary use of secondary use data, then patient identifiable data is OK, depending on user’s rights
crg requirements
CRG Requirements
  • CRG enables patients to use
    • Dissent to Store
    • Dissent to Share
    • Sealed and Locked Envelopes
    • Sealed Envelopes
  • For secondary uses
    • Dissent to store & Sealed and Locked Envelopes - no data available
    • Dissent to share & Sealed Envelopes - data available but not attributable to patient
current sus data flows
Current SUS Data Flows

HES

HES Reports and

Extracts

Reports and extracts

for Commissioners

and Providers

CDS

Pseudon

Stage

Land

PbR

SHA and national

PbR extracts

Commissioning

Dataset Submissions

CDS Activity Warehouse

Extracts for non NHS Organisations

With PIAG approval

future sus data flows
Future SUS Data Flows

Other Data Flows

e.g. Clinical Audits

Reports, extracts

and analyses from

other systems and HES

SUS IG Components

Other

Systems

e.g. Audit

Pseudon

Cohort

Linkage

Geo -

Derive

HES

SUS PDS Copy

PDS Tracing

18 week

CDS

Reports and extracts for

SHAs, commissioners and

Providers

Stage

Land

Commissioning

Dataset Submissions

PbR

CAB

Pseudonymised extracts

for non-NHS organisations

CDS and CAB Activity Warehouse

challenges2
Challenges
  • Ensuring that the data submitted to and available within SUS in the future meets requirements
    • “redefining the information model”
    • “filling the gaps”