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									The Secondary Uses Service (SUS)

     Joint NCRI Informatics – caBIG Conference 13 Jul 07
Information Centre Services
   ASCID - adult social care information development
   Casemix - develops Healthcare Resource Groups (HRGs) to support
    Payment by Results (PbR)
   Health Informatics - standards in collection, management and use. Maintains
    the ‘Skills for Health’ framework
   HES - details of all admissions to hospitals in England via Commissioning data
   Information Governance - the legal and ethical use of data
   National Clinical Audit Support Programme - audits on major diseases
   National Datasets Service - defining the data items, mapping to classifications
    (ICD-10, OPCS-4) & clinical terminology (SNOMED-CT) coding
   Primary Care Statistics - statistics on GPs and dentists
   Prescribing Support Unit - data and consultancy services on prescribing
   Review of Central Returns (ROCR) - data collections coordination
   Statistics & Publications - regular statistical reports & publications
   Secondary Uses Service (SUS) - secondary uses of NHS Care Record data
GENERIC MODEL - END TO END IMPLEMENTATION OF DATASETS

                                                  Local “secondary”                   NHS Wide secondary
            Direct Care
                                                         uses                               uses
                use




                                                                                      Produce and           Access to
                    Use of data in           Access or           Analyse data
Capture of data                                                                    transfer standard       comparative
                   provision of care        extract data           locally
                                                                                        extracts             analysis



Standards for data items maintained in   Standards for data items included          Standard content and schema for NHS wide
local care records                       in local extracts and in local analysis    data flows
                                         systems
Data standards must be supported         Data standards must be supported          LSP reference solutions and existing systems
by LSP reference solutions and           by LSP reference solutions and            must be capable of producing extracts. SUS
existing systems                         existing systems                          must be capable of receiving, managing and
                                                                                   providing access to data and analyses

Issues to be considered:                 Issues to be considered:                    Issues to be considered:
• LSP reference solution development     • LSP reference solution development        • LSP reference solution development
  and release schedules;                   and release schedules;                      and release schedules;
• Capability of existing systems,        • Capability of existing analysis           • Capability of existing systems and
  funding for changes                      systems and funding for changes             XML services and funding for
• Implementation support necessary                                                     changes
                                                                                     • SUS release schedules and funding
                                                                                        for development
    Secondary Uses Service

   A repository of care data for use in care planning, policy development,
    performance management, clinical audit and medical research.
   SUS will provide:
      A consistent environment for data management, allowing better comparison
       across the sector
      Protection of confidentiality through rigorous access controls and removal of
       patient indicators from data transferred from the warehouse
      Access to timely data to analysis and reporting tools
      Better data accuracy and a reduction in the burden for the NHS by
       extracting data from other operational sources where possible, simplifying
       submission processes and carrying out checks on the data submitted
   Overview of the SUS Data Warehouse

                     BT SUS                                 18 weeks
                                                            Reporting

NASP
                                                              CAB
                                                            Reporting    Role
  PDS                                                                    Based
                                                                         Access
                                                              PDS        Control
  CAB                                                       Reporting


                                               Data           Extract
                    Landing      Staging
                                             Warehouse         Mart
 Existing System
                   Processing & Validation
 Providers / LSP
 CDS                                                           PbR      SUS Users
 • A&E                                                         Marts    • Providers
                                                                        • PCTs
 • Future Care
                                                                        • SHA
   Activity                                                  MHMDS
                                                                        • HIS
 • Care Activity                                              Mart      • DH
 • EAL                                                                  • Others
 • APC                                                         HES
 MHMDS                                                         Mart
                                                         Data Marts
History and Origin
SUS is being delivered as part of the
   National Programme for IT (NPfIT)
   National Application Service Provider (NASP) supplier is BT; contract
    awarded in December 2003
   Data are transmitted via the Spine
   Main warehouse being delivered by BT as part of NPfIT, managed by
    NHS Connecting for Health (CFH). The IC works in partnership with
    NHS CFH to develop and implement SUS. Particularly responsible for
    the data definition, analysis and reporting.
   SUS is the single NHS-wide system for processing Commissioning
    Datasets (CDS) and for extracts to support Payment by Results (PbR).
    SUS information is the basis of the Hospital Episode Statistics (HES)
    and Mental Health Minimum Dataset (MHMDS) systems.
What is SUS Designed to do?
SUS is designed to provide:

   Pseudonymised, patient-based data
   A range of software tools and functionality which enable users to analyse
    report and present these data
   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

SUS comprises of:

   A common and consistent information governance model
   Access control
   Use of pseudonyms to replace identifiers
   Design elements e.g. small number suppression and derivation algorithms
    SUS – Move to a Federated Approach

                                   Security and confidentiality ensured by consistent access control and design




                              Landing                                                                              Web based


                                          Staging
                                                                                                     PBC
                                                                                                    Support        application for
                                                     Universal Data
                                                      Warehouse                                                    Practices, PCTs,
                                                                                                                   SHAs


                                                                                                       HES
                              A Core Warehouse and Data Marts


                                             NHS CDS               Other
                               PBR                                                                   Clinical
Data submitted by                             Extract              Extract                                        HES reports and
                                                                                                      Audit
all providers of                                                                                                  extracts
NHS “acute” and
Mental Health Care                 Consistent metadata – business and technical




                                                                                      Extracts for Non NHS
                                                                                      organisations
             Extracts and Reports to all PCTs, Trusts, SHAs
Current Services – Payment by Results
•   The first priority for SUS is the implementation of Payment by Results
    (PbR) The aim of PbR is to provide a transparent, rules-based system for
    paying NHS Trusts for the activity they undertake using a national tariff
•   Under PbR, payment is based on activity and adjusted for Casemix (more
    detail at www.ic.nhs.uk/casemix )
•   PbR ensures a fair and consistent basis for hospital funding rather than
    being reliant principally on historic budgets and the negotiating skills of
    individual managers
•   Providers and Commissioners are then given access to this information,
    providing a consistent basis for negotiation
   A reconciliation exercise is presently underway to further improve the
    quality of data submitted. Once complete, SUS is expected to be formally
    made the definitive PbR data source
   Data is currently provided to organisations but towards the end of 2007, an
    online service will be available, which will allow additional analysis facilities
    to be made available to providers and commissioners
Current Services: Practice Based
Comparators

•  NHS wide web-based comparators available online for the provision of
   GP practice comparators using SUS and QOF data
• Accessible to all GP practices, Primary Care Trusts (PCTs), Strategic
   Health Authorities (SHAs), other trusts and Public Health Observatories
   (PHOs)
Provides access to information on:
• Commissioning activity
• Referral patterns
• Outcomes
• Prescribing
• Quality and Outcomes Framework (QOF)
Key issues: Data Quality

   SUS is populated with NHS data ! Providers and Commissioners have a
    responsibility to make sure that all staff collecting, managing and collating
    data are trained and fully aware that data must be accurate, consistent,
    timely, fit for purpose
   Quality Challenges Improving the content and completeness of
    individual records. Currently invalid and inaccurate data:
     Prevents consistent linkage of data
     Prevents commissioners accessing data
     Leads to incorrect financial payments
     Leads to misleading comparators and indicators
     Increases the unnecessary and inappropriate use of identifiable data
    Data Quality information is currently made available to users at
     http://www.connectingforhealth.nhs.uk/systemsandservices/sus/dataquality
                                                         A&E Attendances for Yorkshire and the Humber SHA

                        250000




                        200000
Number of Attendances




                        150000

                                                                                                                                A&E CDS
                                                                                                                                QMAE

                        100000




                        50000




                            0

                                                                                            RJL
                                 RAE




                                                                               RFR
                                                   RCD




                                                                                                  RP5


                                                                                                        RR8
                                             RCC




                                                                                                              RWA
                                       RCB




                                                                   RCU
                                                            RCF




                                                                         RFF




                                                                                                                          RXF
                                                                                     RHQ




                                                                                                                    RWY
                             SHA Summary to show Percentage
                                Missing Primary Diagnosis
                                        2006/067

10


9


8


7


6


5


4


3
                       2.5

2    1.6                                                            1.6
           1.5                                                1.5
                                                                          1.2
                 0.8               0.9               0.9
1                                           0.5                                 0.6

0
     ALL   Q30   Q31   Q32        Q33       Q34      Q35      Q36   Q37   Q38   Q39
Key development: 18 Week Programme
CDS Version 6
 Enable 18 weeks-specific data items to be loaded into SUS
 Enable reporting via Extract Mart and HES
 Dataset and XML Schema defined and approved by ISB May 07
 Published on SUS & 18 Week Programme web sites

18 weeks SUS application
 Linking events to give ‘Referral to Treatment’ times
 Retrospective and Prospective Reporting
 Business Requirements produced and approved by DH 18 Week Exec Board
 SUS Service Provider developing specification
 Flexible, easily used by non-specialists
 Range of graphical and tabular reports
 Drill down to pathway and patient event level
 Ability to set against comparator data
 Role Based Access Control to limit access
SUS Plans for the next 12 months
June 07       Update to the PBC comparators
              Removal of duplicate data
July 07       Implementation of Interchange Tracker
              eDQRS reporting
Aug 07        Hardware and system software upgrade
              Update on PBC comparators with Q4 data
Sept 07       Upgraded hardware live
Oct 07        Enhanced data quality reporting
              Online reporting for PbR
Nov 07        Compliance testing for CDS v6 data providers
Dec 07        Functional release to accept CDS v6 data, relating to future
              appointments and diagnostic events plus loads from PDS and Choose
              and Book
Mar 08        PbR update for 2008/09 financial year
From Apr 08   New reporting functionality including reports supporting 18 week waits
       IC PROCESS - DATA INTO INFORMATION
                                           DESIGN AND                                               DELIVER
                                                                            .                    INFORMATION                  ANALYSIS
                                            DEVELOP
                                                                                                 SPECIFICATION                SERVICE
                                          INFORMATION
                                          SPECIFICATION




                                                                                                      .
               INPUT                           Content                   Data Process /                                        OUTPUT
DATA    LSPs / existing systems   DATA        XML Schema          DATA   Communication    DATA         SUS          DATA    PbR Datamart
FLOW      capturing standards     FLOW    (Datasets e.g. CDS as   FLOW     PbR Rules      FLOW   Data Warehouse /   FLOW   Extracts & Output
              ICD/OPCS                          enabler)                                            Databases
                                                                            Grouper                                            Datasets


                                              THE SERVICE


                                                   DH
                                                 POLICY
                                                  PbR

                                                 THE IC
                                                Casemix
                                                Datasets
                                                                                                                       PATIENT RECORD
                                                                                                                        INFORMATION
                                                                                                                       SUS Online – User
                                                                                                                      Access to Information

                                               NHS CfH
                                          Data Model/Dictionary
                                              SNOMED-CT


                                         PROVIDES DIRECTION



                                           PROVIDES INPUT
  And then...
 Addition of clinical data and extracts, covering priority areas such as
  cancer, diabetes, heart disease and renal clinical audit
 Data relating to patients’ prescriptions
 Data relating to the primary and social care provided to patients and
  service users allowing linkage of data from all care levels
 The potential uses of a database covering care provided at all levels
  across the whole of England are huge, with an impact on public
  health, research and development and ultimately on the quality of
  care
 At some point, SUS has the scope to expand beyond NHS
  commissioned care to include the addition of other person-specific
  data such as finance, workforce, estates and National Audit Office
  (NAO) information
           CLASSIFICATION INTERDEPENDENCIES

                          THE INFORMATION CENTRE (IC)
                                                               SECONDARY USES SERVICE
 LSPs                                                                 (IC / CfH)
TRUSTs
 SHAs
                                                                          18 week
                                                                          Reporting

                         DATA                                               CAB
                        ITEMS       DATASETS                              Reporting
              SNOMED                                           Landing
  LOCAL        (READ)   e.g. ICD,   e.g. CANCER,                            PDS
   PAS                   OPCS         CDS, HRG                 Staging    Reporting
 SYSTEMS                                  etc.
                                                                DATA
                                                                         PbR Marts
                                                   REFERENCE   RULES
                                                     COST                  MHMDS
                                                    GROUPER                 Mart

                                                                          HES Mart

                                                                         Extract Mart


                                                                         Clinical
                                      CfH
                                                                          Marts


                               DATA MODEL &                      Clinical Feedback
                                DICTIONARY
       Questions now … or later ?

              Monica C M Jones
    Head of NHS National Datasets Service
The Information Centre for health and social care
           monica.jones@ic.nhs.uk
                 www.ic.nhs.uk

								
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