NHS Data Model and Dictionary Service Open Day 20 May 2008 ...

transcript

datastandards@nhs.net

Welcome

NHS Data Model and Dictionary Service

Open Day

vice The NHS Data Model and

Dictionary for England• A collection of definitions about data

• Datum: a single piece of information, as a fact, statistic or code

• Dictionary: a selection of the words of a language, usually arranged alphabetically, giving information about their meanings

The NHS Data Model and Dictionary for England• Model: A simplified view

of reality • allows some ideas to be

shared

Aim of the Day: To enable users to discuss theNHS Data Model and Dictionarywith the National team

• Timings • Toilets• Fire Drill (not planned for today)• Mobile Phones• Smoking - Cavendish Square• Breaks served in the lounge• Lunch served in the lounge

Domestics

vice Agenda

• Introductions • Genitourinary Medicine• What We Do • CDS Version 6• Topical Work • 18 weeks

• Break • Break• Break Out Sessions • Open Discussion• Lunch around 12:30 • Review of the Open Day

• Close no later than 4pm

Some Ground Rules• This will be short, and very boring if we talk

and you listen - challenge us!

• We will discuss current work - this is our direction of travel, not definitive standards

• Your comments will not be attributed to you

Introductions by table

• Your:- Name- Role- Organisation

Questions

• Feel free to ask questions at any time

• If there is an area you want to explore in the open discussion, make a note for later

Slides/ Evaluation• The Open Day Slides will be available on

the NHS Data Model and Dictionary Service website at:http://www.connectingforhealth.nhs.uk/systemsandservices/data/datamodeldictionary/index_html

• An Evaluation Questionnaire will be sent to you by Events Online - please complete it

NHS Data Model & Dictionary ServiceThe TeamThe Team

Summary of Role and Responsibilities:

• Analyse, model and develop change proposals for NHS Data Standards

• Provide support and guidance on NHS Data Standards and the NHS Data Model and Dictionary

NHS Data Model & Dictionary ServiceThe TeamThe Team

Content Manager: Nicholas Oughtibridge

Business Analysts:• Angela Faulding• Bushra Khatoon• Cath Chilcott• David Barnet• Gill Foley

Any Questions

NHS Data Model and Dictionary Service Products

NHS Data Model and Dictionary

NHS Data Model and Dictionary Website

NHS Data Model and Dictionary Consultation

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

Supporting Development

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

NHS Data Model and Dictionary:

The NHS Data Model and Dictionary:

• provides a reference point for assured information standards to support health care activities within the NHS in England;

• together with Data Set Change Notices represent the agreed data standards which should be collected across the NHS.

NHS Data Dictionary Release Cycle• The NHS Data Model and Dictionary is

updated once changes pass their implementation date

• Often this includes April and October• May include other months,

for example February 2008• Each item is independently version

controlled• The history of every change is included with

every item

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

It holds:• News• NHS Data Model and Dictionary• Help (Frequently Asked Questions)• Events• Mailing List• Consultation Website• Publications• XML Schemas• Commissioning Data Set Supporting Information• Link to Data Set Change Notice Website• Useful Links

NHS Data Model andDictionary Service Website

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

Frequently Asked Questions

Categories A-Z Listing Popularity

Sub Categories

FAQ PagesFAQ Pages

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

• Check the NHS Data Model and Dictionary• Look at Frequently Asked Questions• Search other websites:

• e.g. Department of Health, Information Standards Board for Health and Social Care etc

• Contact other Help Desks• e.g. Secondary Uses Service, National

Administrative Codes Service etc.

Options for ResolvingData Definition Queries

Data Definition Queries

Data Standards and Products Helpdesk:datastandards@nhs.net

• full name• job title• telephone number• full postal address • organisation code (if you are an NHS user)• suggested resolution

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

Consultation Website: What is it?• View NHS data standards during

development stages

• Review and comment on work in progress

• Discuss work with the NHS Data Model and Dictionary Service

Consultation Website: Example Sites• 18 weeks• Commissioning Data Set V6• Mental Health Minimum Data Set• Removal of EDIFACT• Genitourinary Medicine Access Monthly

Monitoring Data• Identifying the Responsible

Commissioner• 18 Weeks Clock Rules Suite

Consultation Website: AccessEmail:datastandards@nhs.net

Note: Users granted access to the Consultation Website are automatically added to the NHS Data Model and Dictionary Service Mailing List

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

vice NHS Data Model and Dictionary

Mailing List: What is it?• It is designed to make users aware of NHS

Data Model and Dictionary Service products, such as:

- New NHS Data Model and Dictionary releases

- Forthcoming events such as NHS Data Model and Dictionary Open Days, Training Courses

- Consultation of a draft Change Request

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

Introduction to the NHS Data Modeland Dictionary Training Course• Objective:

Develop a greater understanding of the NHS Data Model and Dictionary

• Target Audience:NHS Information professionals in Trusts, Primary Care Trusts and Health Authorities

• Delivery:2 day course based in Leeds, 6 times a yearNext course June 2008 in Leeds

Course ContentThe training course includes presentations on the following topics:• Background • Data Standards • Change Process • NHS Data Model and Dictionary • Data Validation • Data Modelling • Data Definition Queries

Course Content

On successful completion of the course, participants will be able to:

• Understand the need for Data Standards• Understand how to navigate the NHS Data

Model and Dictionary• Read a Data Model• Use the NHS Data Model and Dictionary to

resolve data definition queries

Website

Frequently Asked

Questions

Training Courses

Open Days

Query Resolution

Mailing List

• Each Change Request:• Requires a:

• Sponsor and• Developer

• Is assured by the Information Standards Board for Health and Social Care

vice Supporting Development

• The Information Standards Board for Health and Social Care:

• provide an independent mechanism for the assurance and sign off of Information Standards for use in the NHS (England)

• publish the assured change as a Data Set Change Notices (DSCN)

DSCN Mailing List:http://www.connectingforhealth.nhs.uk/dscn/mailist

Any Questions

Association for Informatics Professionals in Health & Social Care

ASSISTAssociation for InformationManagement & Technology

Staff in Health

ASSIST National Conference & Awards

Thursday, 22 May 2008London – Oval Cricket Ground

Key note speaker: Matthew Swindells

Book online @ http://www.connectingforhealth.nhs.uk/events/

www.dh.gov.uk

vice National Workforce Data

The Operating Framework for 2008/09

• Electronic Staff Record (ESR) Data Warehouse

• Strategic workforce planning and monitoring purposes

Human Resource and Payroll System for England and Wales

The Operating Framework for 2008/09 Roles & Responsibilities

• Strategic Health Authorities• NHS Trusts• Primary Care Trusts

Expected to profile and monitor their workforce numbers and payroll monthly

National Workforce Data

Introduces data definitions for Workforce

Categories:

1. Organisational2. Personal/Operational3. Deployment4. Education5. Absence6. Staff Movements and Numbers

Key Points:-

• Not linked to Main Specialty Code

• Evolution of Workforce data needs means further releases expected

Cancer Waiting Times Cancer Reform Strategy (2007)

1. Align with 18 weeks data set, cancer registry and radiotherapy collections

2. Incorporate more cancer patients under the 62 day referral to treatment pathway

Continued…

Cancer Waiting Times Cancer Reform Strategy (2007)

3. Include all cancer patients requiring more than one treatment for a primary or recurrent cancer receive all their treatment within 31 days of being ready to start treatment

4. Patients with breast symptoms where cancer is not suspected

Cancer Waiting Times

Support:• Patient Outcomes \ Treatment

Packages• Service reconfiguration and local

planning• Policy development and decision-

making. • Cancer registries and their datasets

Cancer Waiting Times

Key points:

• Extended data set imminent

• Reporting through Secondary Uses service from 2012

New definitions• Consultant led activity / service• Non-consultant led activity / service• Interface Service

Sex and Gender• Sex

A statement, as far as is known, about the phenotypical sex of the person based on observation of his/her biological and physiological characteristics • Not known• Male • Female• Indeterminate

• GenderA statement by the individual about the gender they identify themselves to be (i.e. self-defined)• Not known • Male• Female • Other - The person has a clear

idea of what their gender is, but it is neither discretely male nor female, e.g. agendered, bi-gendered, pan-gendered, transgender, third gender

Sex and Gender• Sex

How the body looks

• GenderHow you choose to behave

Person Sex at Registration and Gender Recognition Act 2004 • The ONS data element ‘Person Sex at Registration’ is the

person’s legal sex • as originally defined at birth registration • and possibly modified by issue of a Full Gender Recognition

Certificate under the Gender Recognition Act 2004. • The ONS may be the source of information for NHS data about

Person Sex. • People who are planning to have their ‘Sex at Registration’ entry

modified must be made aware of the implications of not disclosing their phenotypical sex to a health care professional when seeking health care.

Ethnic Category• Mandating collection in non-admitted settings

including clinics and Accident & Emergency• Updating Commissioning Data Set 10, 20

and 21• Updating Schema for 6-1

Commissioning Data Set 5 closedown

• Commissioning Data Set 5 is no longer the approved standard

• SUS supports the current standard and the immediate past standard

• Release 4 (October 2008) requires a new schema 6-1

• Release 4 cannot support Commissioning Data Set 5

SUS Output• Defining SUS derived

output for• 18 weeks• Mental Health

• Will be used for Performance Sharing for 18 weeks

Breakout

Any Questions

Break Out Sessions

• Developing Standards

• Navigation and the Consultation Website

• Healthcare Resource Group (HRG) 4

• Secondary Uses Service and 18 Week Reports

Healthcare Resource Group 4 (HRG4)

• 33 Expert Working Groups• Managed by the Information Centre

for Health & Social Care• Developed the HRG4 currency• Support Payment by Results tariff

policy

• A major revision of groupings increased from 550 to 1,400

• Focus on cost rather than length of stay

• 25% Increase in OPCS codes

History:

• 2006/7 – Reference Costs used HRG4 for the first time

• Used to inform the 2009/10 national tariff under Payment by Results

Expected:

• 2007/8 – Reference Costs use HRG4

• Use to inform the 2010/11 national tariff

1. Increased clinical coverage:• Specialist Palliative Care• Diagnostic Imaging• Chemotherapy• Radiotherapy• Critical Care• Rehabilitation

2. Improved use of Complications & Co-morbidities:

to reflect variations in severity and complexity

3. Unbundling activity:

to handle high cost drugs and other high cost elements of care

4. Setting independence: unbundling will help to make HRG’s ‘setting independence’

HRG4 – Raise Awareness

Involve clinicians:-• To ensure accurate coding and optimise HRG

classification• To assist in identifying new data items• To help develop meaningful reference costs• To own and use the data• To help you to interpret variations from the

Key Issues for Reference Costs:

• Data Quality• Accuracy• Timeliness• Director of Finance sign-off

The Operating Framework for 2008/09 Standard Contract Clause 29 • From April 2008

-Initially coded datasets weekly-Comprehensively coded datasets monthly

• From April 2009-Secondary Uses Service (SUS) standard repository for reconciliation and payments

The Operating Framework for 2008/09 Standard Contract Clause 29

Failure to comply with the information requirements in terms of:• Accuracy • Completeness • Timeliness

Can result in Main Body, Clause 29 being enacted which can result in funds being withheld

So what – they always say that!Host commissioners can instruct all commissioners to:

• Withhold 10% of income until hosts receive / accept data

• No interest payments on withheld income

HRG4 - Your involvement is vital!Remember:-

1. Raise awareness of HRG4 within your organisation

2. Use OPCS-4.4 or lose money3. Involve clinicians4. SUS will be repository for payment,

reconciliation and performance from April 2009

Data Model Components

NHS Number

NHS Number (Baby)

NHS Number (Mother)

Carer Support Indicator

Data Elements

Local Patient IdentifierOrganisation Code (Local Patient Identifier)Organisation Code TypeNHS NumberBirth Date

Accident and Emergency Attendance

Organisation Code (Code of Provider)Organisation Code (Code of Commissioner)Reporting Period (Mental Health)NHS NumberElectoral Ward of Usual Address

Mental Health Minimum Data Set

Data Sets

PATIENT

ACTIVITY

Classes

Subject of

Relationship

K NHS Number Carer Support Indicator Carer Permission Date Chronically Sick or Disabled Drug Misuse Database Number …..

K Activity Identifier

Attributes

Any Questions

Genitourinary Medicine (GUM) Data Facts…

• GUM is in the 18 weeks Target

• Consultant\Nurse\Midwife-led data must be submitted in the Out-patient Commissioning Data Set

Security Issues and Patient Confidentiality

Sensitive data, such as HIV and venereal diseases must omit the following:-

• NHS Number• Birth Date• Patient Name• Postcode of Usual Address

Genitourinary Medicine (GUM) Data

To be removed from CDS

Genitourinary Medicine (GUM) Data British Association for Sexual Health

and HIV

• Developing a list of venereal disease classification codes

• Exceptions to the sensitive data rule…

GUM Clinic Activity Data Set

Replaces the KC60 Sexually Transmitted Infections Central Return with a patient level data set

vice GUM Clinic Activity Data Set

DSCN 04/2008 - Sensitive Data

• Local Patient Identifier• Lower Layer Super Output Area

of Residence• Age• Gender

GUM Clinic Activity Data SetDSCN 04/2008

Genitourinary Waiting Times

Introduces a new aggregate level data set

Genitourinary Medicine Remember:-

1. Consultant\Nurse-led activity must be transmitted in OP CDS

2. Exceptions to the sensitive data rules

3. Patient Name & Address to be removed from CDS

4. Included in 18 weeks

Commissioning Data Set Version 6

Commissioning Data Set Purpose• Allows organisations to receive activity level

data• Supports Commissioning• Feeds Hospital Episode Statistics• Covers

• Past, current and future admitted patients including day case, long stay and psychiatric

• Past and future out-patients including ward-attenders, nurse/midwife/therapist and diagnostics

• Past Accident and Emergency attendances

Commissioning Data Set Version 6• Evolution over 15 years, not revolution

• Move to re-use common components

• Summary of time-table• Notice of change published in May '06• Schema and Tables published May ’07• Mandatory by 31 March 2008

Commissioning Data Set 6

• XML – protects the integrity of the data• Commissioning Data Set 5 has proved challenging

to some providers• Prevents invalid data for almost all fields

• Exceptions include NACS, ICD, OPCS, READ

Categorisation of Data Quality

Missing

Default Other

Invalid

Categorisation of Data Quality

Missing

Default Other

If the admission is in a series of regular day or night admissions

Then use either National Code 0 or 1

Otherwise, don’t send the field

vice A number

Values 0 or 1

One digit long

Main New Content• Payment by Results

• Paediatric and neonatal critical care

• Discharge ready date

• Age

• 18 Weeks• Pathway identifier• RTTP data items• Future out-

patients• Earliest

reasonable offer date

Big impact - Content• Future out-patients• Elective Admission List• Critical Care• Patient Pathways• Referral to treatment periods• Diagnostic systems

Big impact - Submission• Move to WEEKLY within

5 days of a week end (7 day period)

• Net change protocol for weekly submissions

• Source: Operating Framework

vice Timetable – content

Topic DSCN Publish Collect from

Submit from

Paediatric Critical Care 01/2007 Feb '07 Apr '07 Dec '07

Neonatal Critical Care 15/2006 Aug '06 Apr '07 Dec '07

Age 08/2007 Apr '07 Oct '07 Dec '07

Discharge Ready Date 13/2007 May '07 Oct '07 Dec '07

Patient Pathway 18/2006 Dec '06 Jan '07 Dec '07

Referral to treatment periods 18/2006 Dec '06 Jan '07 Dec '07

Earliest Reasonable Offer Date 09/2007 Apr '07 Oct '07 Dec '07

Diagnostic data flow 02/2007 Feb '07 Oct '07 Oct '07

CDS 5 refresh 27/2007 Aug ‘07 Ongoing Oct '07

CDS 6 XML schema 14/2007 Jun '07 (message) Dec '07

CDS 6 tables 18/2007 May ’07 (message) Dec ‘07

vice Timetable – submission

Topic Implement MandatedDiagnostic data through out-patients Dec '07 Apr '08

Elective Admission List Apr '08

Future Out-patient appointments Dec '07 Apr '08

Use of net change protocol Use of CDS 6

Retire Commissioning Data Set 4 Jul '07

Retire Commissioning Data Set 5 Apr '08

Timely submission (weekly within 5 days of a week end)

Apr '08

Secondary Uses Service extracts Dec '07

When does CDS 5 retire• Formerly: 31 March 2008

• Technically: SUS only supports 2 versions, current and previous. CDS 5 retires as soon as we need any update to CDS 6.

• Expected withdrawal – no later than Oct 2008

CDS Version 6.1• Release: October 2008

• Content Changes: Ethnic Category in:-• Outpatient CDS• Future Outpatient CDS

• Coincide with withdrawal CDS Version 5

Any Questions

Measuring 18 weeks

'By 2008 no one will wait longer than 18 weeks from GP referral

to hospital treatment.'

The NHS Improvement PlanJune 2004

To define and measure the length of wait from GP referral to first definitive treatment

Patient

What are we trying to measure?

Lets look at some pathways

Clinical Assessment Attendance

Walk in centreattendances

Outpatient attendances

Radiologyinvestigations

Physiological Measurements

Elective Admissions

Emergency Admissions

Accident and Emergency

attendances

GP Attendances

Patient

Interface Service

Elective Admissions

attendances

GP Attendances

Patient

InterfaceService

Elective Admissions

attendances

GP Attendances

Patient

InterfaceService

Elective Admissions

attendances

GP Attendances

Patient

Elective Admissions

attendances

GP Attendances

Patient

Elective Admissions

attendances

GP Attendances

Patient

Elective Admissions

attendances

GP Attendances

Patient

What’s new• Multiple stages

• CAS / CATS / ICATS / RMC / Interface Services

• Outpatients, GU Medicine• Admitted Patients

• Multiple providers – “Performance” sharing• Commissioner target

The strategic approach• Measurement using the Commissioning

Data Set• Patient Pathway Identifier to link records• Referral to Treatment Period Status to

identify the anticipated or final status of each activity

• Referral to Treatment Period Start Date and Referral to Treatment Period End Date

Commissioning Data Set Version 6 Type IDs• Accident and Emergency:

010 – Accident & Emergency

• Care Activity:020 – Outpatient021 – Future Outpatient

• Admitted Patient Care:120 – Finished Birth Episode130 – Finished General Episode

• etc…

Referral to Treatment (RTT) Status• First activity

• Subsequent Activity

• Last Activity (First Definitive Treatment)

• Activity that is not part of a Referral to Treatment period

• Not yet known

First Definitive Treatment

the start of the first treatment that is

intended to manage a patient's

disease, condition or injury in a

REFERRAL TO TREATMENT PERIOD

A worked example - ReferralCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10

Future Outpatient CDS

First ACTIVITY in RTT Period

Referral Request

Received Date

A worked example - Appointment CDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10

Future Appointment

A worked example - AttendedCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10

Outpatient CDS

Attendance Date

A worked example - X-Ray bookedCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10021 1 31/1/07 9/1/07 20

subsequent activity in RTT Period- further

ACTIVITIES anticipated

Future X-Ray Date

A worked example - X-Ray attendedCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10021 1 31/1/07 9/1/07 20020 1 31/1/07 9/1/07 20

Outpatient CDS

X-Ray Attendance Date

subsequent activity in RTT Period - further

ACTIVITIES anticipated

A worked example - Decide to admitCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10021 1 31/1/07 9/1/07 20020 1 31/1/07 9/1/07 20030 1 9/1/07 30

Elective Admission List CDS

Anticipated start of the FIRST DEFINITIVE TREATMENT in the RTT Period

A worked example - TCI givenCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10021 1 31/1/07 9/1/07 20020 1 31/1/07 9/1/07 20030 1 9/1/07 30030 1 19/3/07 9/1/07 30

To Come In (TCI) Date

the start of the FIRST DEFINITIVE TREATMENT in

the RTT Period

Elective Admission List

A worked example - AdmittedCDSType

Patient Pathway ID

Activity Date

StartDate

EndDate

RTT Status

021 1 9/1/07 10021 1 24/1/07 9/1/07 10020 1 24/1/07 9/1/07 10021 1 31/1/07 9/1/07 20020 1 31/1/07 9/1/07 20030 1 9/1/07 30030 1 19/3/07 9/1/07 30130 1 19/3/07 9/1/07 19/3/07 30

Admission DateAPC Finished General Episode CDS

Start of the FIRST DEFINITIVE TREATMENT in

the RTT Period

Length of wait measurement

• For waits for non-admitted treatment(RTTP End Date – RTTP Start Date)

• For waits ending in treatment through elective admission

(RTTP End Date – RTTP Start Date) less (RTTP End Date – EROD for admission)

This is the only adjustment to take into account patient choice

“Performance” Sharing• Shares “success” between the organisations

involved in each patient’s care• Used by Healthcare Commission from Jan 09• Taken from Secondary Uses Service• Requires CDS 6 or above with 18 weeks data

Inter-provider transfer• In an estimated 10% to 20% of referral to

treatment periods involve multiple providers• Receiving provider needs Patient Pathway

information at the time of transfer• Will also reduce administrative errors• Many providers are using it internally too

Any Questions

Open Discussion

Review of the day

Please complete the Evaluation Questions which will be sent to you

by Events Online

Thank you for attending

NHS Data Model and Dictionary Service Open Day 20 May 2008 ...

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