Mental Health NHS Providers and System Suppliers
Stakeholder User Group
Friday 9th October 2015 Leeds
Community and Mental Health Team,
Health and Social Care Information Centre
Welcome and Introductions
Nicholas Richman
Service Development Manager (Community & Mental Health)
Welcome and introductions
•
•
•
•
•
•
Welcome
Introductions
Fire exits
Toilets
Agenda for the day
Political context
Scene Setting
Nicholas Richman
Service Development Manager (Community & Mental Health)
4
Background
• Parity of Esteem (for mental health with
physical health)
• IAPT “gold standard”
• 16 care pathways
• Access target
• NICE concordant interventions
• Outcome measures
5
16 Care Pathways
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Psychoses incl.Schizophrenia
Bi polar disorder
Depression
Anxiety disorders
Obsessive compulsive disorder
Phobias
Organic brain disorders including Dementia
Alcohol and drug misuse
Somatoform disorders
PTSD
Eating disorders
Perinatal disorders
Personality disorders ( 10)
Self harm behaviours
Conduct disorders in children
Neurodevelopmental conditions
– ADHD
– Autistic spectrum disorders
6
Implementation approach
• “Big bang” approach – sorry for truncated
timescales
• Use of SNOMED should mean fewer, smaller
data set changes which should mean faster
implementation of future changes e.g.
Forensic PbR
• Report to minister on preparedness – early
October
7
MHSDS ISN (SCCI0011)
• ISN published on 16th July 2015, available here:
www.hscic.gov.uk/isce/publication/SCCI0011
• Additional information can be found here:
www.hscic.gov.uk/mhsds
• Supplier compliance by 1st January 2016
• Providers start collection on 1st January 2016
• Providers start submitting from 1st February 2016
• Submission still in IDB format not XML for this release
• Incorporates CAMHS, LD Census and CYP IAPT
• Introduction of clinical terminology (SNOMED CT)
• Move to relational structure in line with other data sets
8
Transition arrangements
• December – only primary MHLDDS submission
closing 23rd January 2016
• No December refresh to give time for changeover
• Will carry out Operational Assurance Testing with
providers
• January MHSDS submission 1st – 22nd Feb (tbc)
• Publication of EIP waiting times by the end of
March – with DQ information per provider where
data not available
9
An Introduction to SNOMED CT
UK Terminology Centre
presented by Ian Spiers, Clinical Terminology Specialist
Agenda
•
•
•
•
•
Strategy
What is SNOMED CT
Withdrawal of the Read codes
Use in Mental Health
Further resources
11
Strategy
Vision:
Patient centred care; patients view their EPR
Actions:
– Paperless
– Interoperability – move data around electronically
– Move from additional collections for national data
returns to data extraction from the EPR
12
Electronic records, national vocabulary
Using a single national vocabulary will ensure that data
collected in different systems can be transferred and
‘understood’ by the different systems.
It also means each organisation is not spending time
developing their own clinical vocabulary
The international vocabulary the UK has selected is
SNOMED CT.
The UK has made substantial investment in this and is
one of the founder members of the not-for-profit
organisation that manages SNOMED CT
13
Framework for Action
‘The NIB endorses the move to adopt a single
clinical terminology – SNOMED CT – to support
direct management of care, and will actively
collaborate to ensure that all primary care
systems adopt SNOMED CT by the end of
December 2016; the entire health system
should adopt SNOMED CT by April 2020.
During this time, we must also work with local
authorities to understand and address the
implications of this for social care’.
14
What is SNOMED CT?
Sitting Blood
pressure
Blood
pressure
Lung
von Recklinghausen's bone
disease
A national common vocabulary of ‘Clinical
phrases’ for electronic systems
toe
mild
moderate
inflammation
finger
severe
acute
phlegm
ischaemic
infection
exertional
angina
bacterial
cough
viral
SNOMED CT Content
Clinical
Findings
Causes of
Disease
Procedures
•
•
•
•
Disease and deformity – scar
Symptoms – difficulty breathing
Social – walking aid use
Examination findings – tachycardia
• Forces – pressure change
• Events – road traffic accident
• Organisms – felis silvestris (cat)
•
•
•
•
Laboratory
Therapy / regimes
Investigation
Operation
SNOMED CT Content
Anatomy
Observations
Products
• Normal – knee joint
• Abnormal – ganglion cyst
• Lesions – bony callus
• Vital signs – blood pressure
• Body product properties – normal saliva
• Values - present
• Drugs and appliances – paracetamol
• Substances – latex
• Devices – bedpan
A Concept in SNOMED CT
Preferred Term: Heart Disease
Synonym: Cardiopathy
Synonym: Disorder of Heart
Synonym: Morbus Cordis
Synonym: Cardiac Disorder
Synonym: Cardiac Diseases
Synonym: Heart Diseases
Heart disease (disorder)
56265001
Relationships
Is a cardiac
finding
Is a disorder of
mediastinum
Is a disorder of
cardiovascular
system
Finding site
heart
structure
Severity
Episodicity
Courses
A Concept
Codes and descriptions
Relationships
Is a
Attributes
Qualifiers
& values
A Concept in SNOMED CT
FSN: Fully specified name
Preferred Term: Irritable bowel
syndrome
Synonym: Irritable bowel
Synonym: Irritable colon
Synonym: Irritable colon
syndrome
Synonym: Membranous colitis
Synonym: Spastic colitis
Synonym: Mucous colitis
Irritable bowel syndrome
(disorder) 10743008
Relationships
Is a
disorder of
intestine
Finding site
Intestinal
structure
Severity
Episodicity
Courses
Disease
Infectious disease
Disorder by body site
Infection by site
Disorder of trunk
Bacterial infectious disease
Disorder of thorax
Respiratory tract infection
Bacterial infection by site
Disorder of lung
Lower respiratory tract infection
Lung consolidation
Pneumonia
Bacterial respiratory infection
Infectious disease of lung
Infective pneumonia
Bacterial lower respiratory infection
Bacterial pneumonia
UK Terminology Centre (UKTC)
• Maintenance
– Request for change
• Distribution
• Governance
– Editorial
– Strategic
– Corporate
22
Requests for change
23
Distribution
24
How do I look at SNOMED CT?
• Using a browser application
• http://systems.hscic.gov.uk/data/uktc/snomed
/browser
• On-line:
– IHTSDO
– Snow Owl
– Snoflake
• On your machine – need access to install
– Cliniclue
25
Is it used ?
• Cerner Millennium
• Lorenzo
• Rio
• MediTech
• Allscripts
• EPIC
• Summary Care
Record
• eReferrals
• Spine
• Care.data
26
Early adopter trusts …
• Have over 7 years worth of data …
• And are shifting to more clinical based
management
27
SNOMED CT: evolved to address issues
• Changes undertaken
through DH driven
projects
• NPFiT required
SNOMED CT
Read v2
Read v3
(CTV3)
• In the process of
withdrawing the
Read codes
SNOMED
CT
Timescales
•
•
•
•
•
The Read codes are deprecated
April 2016: Last release of Read v2
Proposing CTV3: no release in October 2016
April 2018: Last release of CTV3
April 2020: Withdrawal of Read
29
Use of SNOMED CT in Mental Health
Access and Waiting Times Standards in Mental Health
Timely access to evidenced based care
• The National Collaborating Centre for Mental Health (NCCMH) has
been commissioned by NHS ENGLAND to develop national resources
to support implementation of these standards.
• NCCMH are producing commissioning guides on establishing and
maintaining services for Early Intervention Psychosis and Eating
Disorders.
• UKTC has worked with the NCCMH and their Expert Reference Groups
to map SNOMED CT content to NICE concordant interventions for
publication in the guides and to support implementation of NICE
Guidance and Pathways in the electronic health record (EHR).
30
Use of SNOMED CT in Mental Health
• Subsets of SNOMED CT will be available for download for
system suppliers to use in electronic health records. This will
enable clinicians to access SNOMED CT content relevant to
NICE concordant interventions and facilitate central data
collection and analysis derived from the EHR.
• The subsets are condition focused with Early Intervention
Psychosis and Eating Disorders completed for release in October
2015. This work is ongoing with the next focus to be on Perinatal
Mental Health.
31
Resources to help develop an understanding of SNOMED CT
UKTC website: http://systems.hscic.gov.uk/data/uktc/training
NHS Networks: SNOMED CT NHS Network
Case Studies
from someone
using it for real
Why
SNOMED CT
An overview
Brochure
Finding out
more…
• Leeds A&E Department
• Moorfields Eye Hospital
• Rotherham Foundation Trust
• University Hospitals Morecambe Bay
• Barts Health
SNOMED CT
Webinars
• Introduction to SNOMED CT
• Finding Content in SNOMED CT
• Clinical Data Analysis
How do I view
SNOMED CT
content?
• Browsers for SNOMED CT data
• On-line Browser
Where Can I
ask questions?
• Email: snomedtraining@nhs.net
• Discussion Groups: NHS Networks
eLearning
• ON HSCIC TRUD
• UKTC Education and Training Resources
How SNOMED-CT applies to the Data Set
Nicholas Richman
Service Development Manager (Community & Mental Health)
PK
Local Patient Identifier (Extended)
Organisation Code (Local Patient Identifier)
Organisation Code (Residence Responsibility)
Organisation Code (Educational Establishment)
NHS Number
NHS Number Status Indicator Code
Person Birth Date
Postcode of Usual Address
Postcode of Main Visitor
Person Stated Gender Code
Ethnic Category
Religious or Other Belief System Affiliation Group Code
Language Code (Preferred)
Person Death Date
Clinical Terminology Diagnosis
MHS601 Medical History (Previous Diagnosis)
FK1
Local Patient Identifier (Extended)
Diagnosis Scheme in Use
Previous Diagnosis (Coded Clinical Entry)
Diagnosis Date
MHS603 Provisional Diagnosis
MHS604 Primary Diagnosis
MHS605 Secondary Diagnosis
FK1
Service Request Identifier
Diagnosis Scheme in Use
Provisional Diagnosis (Coded Clinical Entry)
Provisional Diagnosis Date
FK1
Service Request Identifier
Diagnosis Scheme in Use
Primary Diagnosis (Coded Clinical Entry)
Diagnosis Date
FK1
Service Request Identifier
Diagnosis Scheme in Use
Secondary Diagnosis (Coded Clinical Entry)
Diagnosis Date
MHS606 Coded Scored Assessment (Referral)
FK1
MHS101 Service or Team Referral
PK
Service Request Identifier
FK1
Local Patient Identifier (Extended)
Organisation Code (Code of Commissioner)
Referral Request Received Date
Referral Request Received Time
NHS Service Agreement Line Number
Service Request Identifier
Coded Assessment Tool Type (SNOMED CT)
Person Score
Assessment Tool Completion Date
Clinical Terminology Relational Structure
Clinical Terminology Data Structure
SNOMED CT Description
SNOMED CT Code
Health of the Nation Outcome Scale for Children and Adolescents item 1
- disruptive, antisocial or aggressive behaviour (observable entity)
895191000000100
Health of the Nation Outcome Scale for Children and Adolescents item 2
- overactivity, attention and concentration (observable entity)
895211000000101
Health of the Nation Outcome Scale for Children and Adolescents item 3
- non-accidental self injury (observable entity)
895231000000109
Health of the Nation Outcome Scale for Children and Adolescents item 4
- alcohol, substance/solvent misuse (observable entity)
895251000000102
Care Activity Identifier
Coded Assessment
(SNOMED CT)
Assessment Score
12345
895191000000100
1
12345
895211000000101
3
12345
895231000000109
2
12345
895251000000102
4
12350
895191000000100
2
12350
895211000000101
2
37
Questions & Answers
Lunch
12.15 – 13.15
Reporting of Child and Adolescent Mental Health &
Children and Young People’s IAPT
presented by Dominic Gair, Section Head – Community
Background
• The MHSDS provides opportunity for a wealth of CAMHS
data to be collected consistently at a national level for the
first time.
• As with all new datasets it is expected that there may
initially be data quality issues that arise and we will work
closely with providers to help identify and address these as
they do.
• Initial reporting of CAMHS data will be as Experimental
Statistics. As the dataset matures this will change and the
data will become fit for a wider variety of beneficial uses.
41
Intended Future Reporting
• A basic report with an associated data quality to be
published monthly
• A more detailed annual report to be published
• Data will also be made available via the use of a
Business Intelligence tool called iView Plus which
will be refreshed monthly
– More interactive
– Allows:
– Filtering, Charts, Hierarchies, Maps, Dashboards and adhoc queries by the end user.
42
What is iView Plus
•
An online data visualisation tool
•
For members of the public and healthcare professionals
•
Allows access to aggregated HSCIC data
•
Flexible and interactive
•
Free view user or Registered user options
•
iViewPlus development commenced April 2015
•
System go live at the end of 2015 and will gives access to various data
areas initially from MCDS datasets. Maternity data will be available at
launch with CYPHS and CAMHS data to follow early in 2016.
43
iViewPlus
The national provider of information, data and IT systems for health and social care
Home
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Sets
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Welcome to the Maternity Services Data Set (MSDS)/Home
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You are viewing MSDS for August 2015
LATEST NEWS
01/10/2015
Maternity Services (MSDS) report
published
The report that examines the current sources
of maternity data has been published by the
Health and Social Care Information Centre.
Maternity Services Data Set
The Maternity Services Data Set (MSDS) has been developed to help achieve better
outcomes of care for mothers, babies and children. The data set will provide
comparative, mother and child-centric data that will be used to improve clinical quality
and service efficiency; and to commission services in a way that improves health and
reduces inequalities. As a 'secondary uses' data set, it re-uses clinical and operational
data for purposes other than direct patient care. Information from the data set will be
made available to commissioners, providers, clinicians and service users and will be
used to record, compare and improve outcomes and safety improve clinical quality and
service efficiency commission services in a way that improves health and reduces
inequalities improve accountability by providing comparative information to service users
provide activity data on which to base mandatory tariffs for Payment by Results
What information is available?
Information from the data set will be
made available to commissioners,
providers, clinicians and service users
and will be used to record, compare and
improve outcomes and safety improve
clinical quality and service efficiency
commission services
Maternity Services
Data Set report
View statistical publications by date on the
Publications Calendar
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July 2015
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Benefits of iViewPlus
• Enables greater interactivity between users
and the data.
• Easily accessible
• Ability of users to create and share
dashboards that meet their own local needs
and requirements.
iViewPlus and CAMHS Data
• Not all reported data fields will be available
on iViewPlus at first rather a staged approach
will be adopted.
• We will be working with customers to
determine key reporting requirements in
order to prioritise which information is made
available in iViewPlus and when it will be
available.
52
Feedback
• We welcome any feedback in regards to the
functionality of iViewPlus and how this may
help your reporting needs.
• This maybe sent to enquiries@hscic.gov.uk
please include the words iViewPlus and
CAMHS within the subject title of the email.
Adult Mental Health Analysis
September 2015 Provider and Supplier Stakeholder User Groups
presented by Jo Simpson, Senior Project Manager – Mental Health
Overview
• Annual Publications
• Experimental Data File
• Adult Mental Health Analysis from the
MHSDS
• Early Intervention in Psychosis (EIP) Access
and Waiting Times
Annual Publications – Mental Health Bulletin 2014/15
• Annual analysis of data from the
MHMDS/MHLDDS
• Published on the 23rd October 2015
• Format similar to last year
• No special feature this time, but more
analysis of MHA…
Annual Publications – KP90 2014/15
•
Annual analysis of data about uses of the Mental Health Act (MHA)
1983
•
“Inpatients Formally Detained in Hospitals Under the Mental Health Act
1983 and Patients Subject to Supervised Community Treatment”
•
Published on the 23rd October 2015
•
Streamlined version of last year’s report
•
Clearer demarcation of data sources following feedback from UK
Statistics Authority
•
Will continue next year, but plan to retire
Experimental Data File
•
The Monthly MHLDS Report from April 2015 data (published in June) includes
an additional data file of measures relating to two current areas of interest in
secondary mental health services:
–
–
the introduction of access and waiting time measurements for mental health services
the use of out of area placements for people requiring mental health hospital care
•
This data is presented as experimental analysis because the current structure of
the data source (MHLDDS) does not support the measurement of waiting times
for individual referrals into services, nor does it include the detail of contracting
arrangements that might reliably identify an out of area placement.
•
For both topics the measures presented in this file are a proxy, designed to
inform discussion, prompt local investigation into any recording issues and
provide a reference point for more accurate measurement in future.
•
Details of how each measure has been constructed from the dataset are
included in the metadata file that is part of the MHLDS Monthly Report.
Adult Mental Health Analysis from the MHSDS
• The MHSDS is a significant change for us too!
• Significant opportunity:
– Closer fit to how services are delivered
– Pathway analysis
• Limited analysis initially, with a focus on EIP
• Publish analysis on provisional data for the first
time
Adult Mental Health Analysis from the MHSDS
• Changes to the structure of the dataset from a person based
dataset to a referral based dataset give us the opportunity to
review the content and format of our existing publications.
• We are seeking information about which measures and which
elements of existing publications are most useful to you.
• We want to ensure that the data collection continues to be
relevant and meaningful to the people who use it, and that we
are meeting your information and data needs in the best and
most cost-effective way.
• Ideas for EIP contextual measures
• Consultation now closed – results to be published in November
Adult Mental Health Analysis
•
In response to user feedback the validation on many ‘event’ type tables
(i.e. those where a status or activity is recorded against a single date,
such as Employment Status Recorded Date) has been relaxed.
Depending on the type of event, the date validation may be ‘within
reporting period’ or ‘date is not after end of Reporting Period’ for
example.
•
This will help in the monitoring of established measures such as
‘Employment status for people on CPA’ and ‘people on diagnosis at end
of reporting period’ by allowing some events that preceded the current
reporting period to flow with referrals open in the current reporting
period, as shown in the examples highlighted below.
•
Please read the TOS with care and ensure your extracts for the new
MHSDS submissions are built according to these revised date
validation rules.
Adult Mental Health Analysis
Data Item / Table
Validation Rule
Change from MHLDDS
Current Measure Impact
ACCOMMODATION
STATUS RECORDED
DATE
(MHS003AccommStatus)
If Accommodation Status
Recorded Date is after
the end of the reporting
period, the record will be
rejected.
Validation relaxed, any
status not submitted within
the associated RP can still
be submitted in any
subsequent RP.
mm13 - People with accommodation
status recorded
mm14 - People aged 18-69 on CPA in
settled accommodation
mm15 - Proportion of people aged 18-69
on CPA in settled accommodation
EMPLOYMENT STATUS
RECORDED DATE
(MHS004EmpStatus)
If EMPLOYMENT
STATUS RECORDED
DATE is after the end of
the reporting period, the
record will be rejected.
Validation relaxed, any
status not submitted within
the associated RP can still
be submitted in any
subsequent RP.
mm16 - People with employment status
recorded at the end of the RP
mm17 - People aged 18-69 on CPA at the
end of the RP in employment.
Mm18 - Proportion of people aged 18-69
on CPA in employment
DIAGNOSIS DATE
(MHS604PrimDiag)
If DIAGNOSIS DATE is
after the end of the
reporting period, the
record will be rejected.
CARE PROGRAMME
APPROACH REVIEW
DATE
(MHS702CPAReview)
If CPA REVIEW DATE is
after the end of the
reporting period, the
record will be rejected.
Validation relaxed, any
mm20 - People with a diagnosis recorded
diagnosis not submitted
within the associated RP
can still be submitted in
any subsequent RP.
Validation relaxed, any
mm06 - People on CPA for 12 months with
review not submitted within review
that RP can still be
submitted in any
subsequent RP.
EIP Access and Waits
•
The new access and waiting time standard requires that, by 1 April
2016, more than 50% of people experiencing a first episode of
psychosis will be treated with a NICE approved care package within two
weeks of referral.
•
The standard is ‘two-pronged’ and both conditions must be met for the
standard to be deemed to have been achieved, i.e.
– A maximum wait of two weeks from referral to treatment; and
– Treatment delivered in accordance with NICE guidelines for psychosis and
schizophrenia - either in children and young people CG155 (2013) or in adults
CG178 (2014).
•
Most initial episodes of psychosis occur between early adolescence
and age 25 but the standard applies to people of all ages in line with
NICE guidance.
Page 9, Guidance to support the introduction of access and waiting time standards for mental health services in 2015/16
EIP Access and Waits
• Clock Start –
– Referral received with a primary or other reason for
referral of ‘01 (Suspected) first episode psychosis’
• Clock Stop –
– Care co-ordinator assigned following an attended
face to face contact
• No pauses
• Measures and reporting session later in the year
MHSDS Extracts
Presented by Amina Butt
Senior Information Analyst
MHLDDS
• Submit 50 tables in an IDB to OpenExeter
• Most tables are validated to ensure that they
contain activity during the reporting period
• A spell index is maintained ensure a record
for each person’s spell of care
MHLDDS Extracts
• The 50 tables are then transformed into 4
CSV files
–
–
–
–
Header
Record
Event
Episode
67
MHSDS
• Submit 48 tables in an IDB
• Most tables will be validated to ensure that
they contain activity during the reporting
period
• Records will also be validated for referential
integrity
• No spell index!
68
MHSDS Extracts
• After processing these tables are transformed
into 48 tables in an xml file
• Can be easily imported into Access or SQL
• Quick Demo
69
Learning Disabilities
Presented by Clare Burgeon
70
Learning Disabilities
• LD Census – running 30th September 2015 –
last time
– Content in MHSDS
• Assuring Transformation collection – some
changes
– When MHSDS is live, we will revisit content of AT
collection
• Triangulation of census, AT and data set
71
MHLDDS findings – May 2015
Change
from
previous
Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 month
End of month counts
People in contact with LD
services*
People in a learning
disabilities ward
52,410 54,143 55,385 56,292 56,496 56,640
1,797
1,543
1,606
1,544
1,773
1,550
144
-223
Next Steps
Presented by Aaron Leathley - Senior Data Sets Maintenance Analyst (Community & Mental Health)
MHSDS Future Development Timeframe
• April 2016 was put forward due to Forensic
Mental Health Tariff reporting requirements
• Initial review by SCCI in August
• SCCI recommend delaying release
74
Requested changes for future MHSDS
•
•
•
•
Bug fix release!
Ward specific changes
Forensic Mental Health Tariff
Community Eating- Disorder Services for
Children and Young People (CEDS-CYP)
• Assuring Transformation
75
Bug Fixes - Minor Changes
• Align tab name in Technical Output
Specification and IDB for “MHS006 Mental
Health Care Coordinator” (IDB/tab says
MHS006AssignedCareCoOrd)
• Other changes identified throughout
implementation
76
Ward Specific Changes
• Remove ward specific references to ‘Adult’
and ‘Older Peoples’ and change to
‘Functional’ and ‘Organic’
• May include an indicator to show whether the
ward is locked/unlocked
77
Forensic Mental Health Tariff
• Pilot item ‘Forensic Mental Health Care
Cluster Code’ will be changed to required and
a value list provided
• Collection of Forensic 5 Pathways allocation
• Collection of F-MHCT andHCR-20
assessments
• Question over which version (v2 or v3) of
HCR-20. May need to include both, subject to
licensing arrangements
78
CEDS-CYP
• Specifically for CEDS-CYP Teams funded
under new NHS England arrangements
• New team type in the ‘MHS102 Service or
Team Type Referred To’ table and others…
79
Assuring Transformation
• Changes to reflect updated version of current
AT collection (include Care and Treatment
Reviews, remove Winterbourne View items)
• Revised AT collection potentially released in
November 2015
• Specific changes will be identified in the
revised version of the MHSDS Technical
Output Specification
80
Questions and Answers