02/12/2012
1
Agenda
• DMICs and their place in the NHS
• IG landscape
• DMIC development project
– DMIC Network
– DMIC Technical
02/12/2012
SEPHIG 5-Dec-2012
2
CSUs and DMICs
CSUs
•
•
•
CSUs will provide CCGs with external support,
specialist skills and knowledge, e.g. business
intelligence services, clinical procurement services,
business support services such as HR, payroll,
procurement of goods and services and some
aspects of informatics etc. to support them in their
role as commissioners.
CCGs have the freedom to decide which
commissioning activities they do themselves, share
with other groups or buy in from external
organisations.
Will be externalised in April 2016
02/12/2012
DMICs
•
•
DMICs will collate commissioning
intelligence pertaining to a number of CCGs,
and provide this to other elements of the
health service infrastructure including other
CSUs.
The structure of DMICs is varied; some are
hosted by a subset of the CSUs, others
operate as collaborative shared service
across a number of CSUs .
What are DMICs?
They are
The official NHS data processing and linkage orgs
Hosted by CSUs or operating as Shared Services
They are not
Virtual organisations
3
Old-world
Organisation
Relationships
4 x PAN SHAs (e.g. Y52)
10 x SHAs (e.g. Q38)
151 x PCTs (e.g. 5QE)
(50-ish PCT Clusters)
8,500-ish GP Practices
02/12/2012
4
-0aa
02/12/2012
DMICs
New-world
Organisation
Relationships
1 x NHS Commissioning Board
4 x Commissioning Regions (e.g. Y57)
27 x Local Area Teams (e.g. Q69)
22 x Commissioning Support Units
9 x Data Management and Integration Centres
211 x Clinical Commissioning Groups
8,500-ish GP Practices
5
Geography of CSUs and
DMICs
CCG/Practice mapping
23 Commissioning Support Units
9 DMICs
http://www.connectingforhealth.nhs.uk/
systemsandservices/data/ods/ccginterim
Stop press:
0AF + 0AN = 0CE
NHS Cheshire and Merseyside
9 Data Management Integration Centres
Indicative
02/12/2012
6
How intelligence will be delivered
National Bodies
incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public
National
National Data Feeds
Provider National flows
Audits
Care.data
ONS
National/ International
Surveys
HSCIC
Conformed data supplied back
up to care.data
Local Data Feeds
Sub-national
Safe haven
Provider (Local flows)
DMIC x ~9
Wider Determinants
Alternative providers
Safe haven
3rd Sector
LATs
DMICs may also
provide data
to wider stakeholders
CSU
X~27
X~23
Local
Small no CCGs doing
own intelligence
CCGs
CCG
x~210
LAPH
CCG
X~150
Data Flows
To enable the
widespread use
of de-identified
data in the NHS,
consistent data
quality, validation
checks & linkage
need to be
undertaken.
Due to the vast
amount of locally
defined
unconformed
datasets,
a small number of
DMICs have been
proposed to
undertake the
data processing
on behalf of local
CCGs, CSSs and LA
PH
02/12/2012
7
CSU/DMIC schedule
Apr
2013
Apr
2014
CSUs and DMICs
operational
Apr
2015
Apr
2016
CSU s externalised
• What does DMIC operational mean?
• Main issues are
–
–
–
–
–
But first ..
Operational readiness
Data Interoperability – both ‘up’ and ‘down’
Pseudonymisation
PbR rules
What about
Industry liaison
02/12/2012
IG?
8
NHS Act 2012 and IG
• Tim Kelsey’s vision
• Many practical issues unresolved in the Act
– Section 251 needed to support flow of PID outside the HSCIC
– PCTs do much more than just commissioning (e.g. Urgent Care)
– Patchy implementation of pseudonymisation
• Sharing data and linking it together will improve
–
–
–
–
whole system understanding
enable pathway monitoring across health and social care
identify system interdependencies
facilitate correlations between treatments, experience and
outcomes
Section 251 - sets aside the common law duty of confidentiality for [direct] medical purposes
• where it is not possible to use anonymised information and
• where seeking individual consent is not practicable.
02/12/2012
9
Commissioning Intelligence Model
The business intelligence needs to
support health commissioners can be
framed as a set of questions that need
help answering.
• How healthy?
• What’s really happening?
• How much?
• How good?
• Are Providers delivering?
• Could things be better?
• Have we made a difference?
• What are our future plans
02/12/2012
10
Commissioning activities
requiring PID
The seven scenarios where Commissioners need access to PID
1. Integrated care and monitoring services including outcomes &
experience requires linkages across sources
2. Commissioning the right services for the right people requires the
validation that patients belong to CCGs and have received the correct
treatments
3. Aspects of service planning and monitoring on geographic data basis
require postcodes for certain type of analysis
4. Understanding population and monitoring inequalities
5. Target support for patients and population groups at highest risk
requires data from several sources linked together
6. Specialist commissioning is commissioned outside local areas and can
require wider discussions about individual patients and their associated
costs
7. Ensuring appropriate clinical service delivery and process requires
access to records
02/12/2012
11
Caldicott2 review and need
for interim position
• It is agreed by all that there is a need for a holding
position
• To enable commissioning, PID including NHS no, DOB,
Postcode data needs to flow to DMICs
– The DMICs need to have similar powers and controls to the
HSCIC to process data
– In order for processing of PID at DMICs to be undertaken
legally, a change in legislation will be required
– Legislative changes can not be achieved by April 2013
• Caldicott2 report expected Jan/Feb 2013
• DMICs need to be operational in April 2013
02/12/2012
12
Proposed organisational access to PID for commissioning uses
Organisation
HSCIC
Safehaven
DMIC x ~9
safe haven
Require PID flows
For data linkage & validation
for national flows (by small
no defined roles)
LATS
X-27
Facilitates wide use
of quality linked de-id
data for wider
agencies
Facilitates wide use
of quality linked deid data for
commissioners
between national and local
flows(by small no defined
roles)
X~23
Small number roles which can
not be done without use of
PID via role based access
Enables types of
Commissioning
(as per slide 12)
Small number roles which can
not be done without use of
PID via role based access
Enable aspects of
service monitoring
Access to postcode level data Enables geographic
via role based access
analysis
To monitor at risk
Access to PID data
populations
LAPH
X~150
Patient level de-identified data
suitable for all aspects of work
May require PID if do not use
CSU or LAPH
CCGs
x~212
02/12/2012
as per previous slide
For linkage & validation
CSU
Clinicians
Exceptions requiring controlled Justification
access to PID
Identifying at risk patients
Enables proactive
patient care
1
3
DMIC interim options
• What are the
options?
– Do nothing - illegal
– Send all data flows to
HSCIC - impracticable
– DMICs part of NCB &
apply for section 251
- limiting
– DMICs linked with IC
+ IC special powers –
continuity
02/12/2012
• General agreement that DMICs
need PID
• NCB will not allow anything illegal
• Continuity option may still
need section 251
14
How intelligence will be delivered
National Bodies
incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public
National
National Data Feeds
Provider National flows
Audits
Care.data
ONS
National/ International
Surveys
HSCIC
Conformed data supplied back
up to care.data
Local Data Feeds
Sub-national
Safe haven
Provider (Local flows)
DMIC x ~9
Wider Determinants
Alternative providers
Safe haven
3rd Sector
LATs
DMICs may also
provide data
to wider stakeholders
CSU
X~27
X~23
Local
Small no CCGs doing
own intelligence
CCGs
CCG
x~210
02/12/2012
LAPH
CCG
X~150
Data Flows
To enable the
widespread use
of de-identified
data in the NHS,
consistent data
quality, validation
checks & linkage
need to be
undertaken.
Due to the vast
amount of locally
defined
unconformed
datasets,
a small number of
DMICs have been
proposed to
undertake the
data processing
on behalf of local
CCGs, CSSs and LA
PH
1
DMIC development
• DMIC network and technical groups meet monthly
• DMIC Network concerned with authorisation
–
–
–
–
CP2 (Jun 2012) authorised 9 DMICs to proceed
CP5 (Feb 2013) will accredit DMICs as viable
Liaison with industry groups
ISO standards
• DMIC technical focusses on service delivery
– Interoperability
• SUS
• Customers
– Pseudonymisation
02/12/2012
16
DMIC Technical issues
• Access to SUS extracts
– DME marts proposed – db 2 db data transfer
– IG issues to resolve
• Input to DMIC – six data feeds supported
GP data
SUS inpatients
Community
SUS outpatients
Mental health
SUS accident&emergency
• Output from DMIC data processing in the form of Logical Data models
– 3 logical models submitted to standards (IP, OP, A&E)
– 3 more under discussion (GP, Mental health and Community)
– 3 more proposed for 2013-14 (111/OOH, Ambulance and Referrals)
• Common Pseudonymisation policy
• Re-identification and web
service
• Common algorithm
• Simple implementation in
advance of Caldicott2
02/12/2012
One possible interoperability set-up
17
Data service in 2013-14
• Reality check
– Not everything will happen by April 1st 2013
– SUS will not shut down PCT SUS feeds
– New organisation hierarchy on some national systems
from January
– CCG IG function not fully operational
– Many CSU BI systems will not be ready by April 1st 2013
• Therefore,
– BAU systems will continue to operate through early part of
2013-14
– IG guidance will gradually be applied
– The dust will settle as newly authorised organisations take
on their statutory duties
02/12/2012
18
Thank you for listening
Any questions?
02/12/2012
19
Hand-out - commissioning
activities requiring PID
02/12/2012
20