HSCIC primary care overview
General Practice Extraction Service
(GPES) Implementation Update
Dave Roberts
Head of Primary Care Strategy, HSCIC
EMIS National User Group
Thursday 6 September 2012
1.
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8.
GP practice data
Patient access to medical records
Prescribing data
Pathology
MIQUEST query service
MIQUEST ownership and future
Education, Training and Development
GPES
1. GP practice data
Transparency
Phase 1
•
On the 7 December 2011, as part of the Government’s commitment to ‘open up our
public services’ DH in partnership with the Health and Social Care Information Centre
released (IC) 260 data items, covering 8,300 GP Practices in England through the
Indicator Portal.
•
The data is structured under 5 key headings:
- Demographics
- Patient Experience
- Quality Outcomes
- Infrastructure
- Impact on NHS Resources
•
The portal provides a single source of comparable data, appearing in a flat file
format, primarily for data intermediary usage.
•
Currently the portal enables the technical audience to compare practices, make
choices and hold local services to account, whilst the NHS Choices site aids the
public and patients in making practice decisions and simple comparisons.
Transparency
Phase 2
•
To further support the work the IC will develop a ‘tool’ enabling GPs and other
stakeholders e.g. emerging CCGs or HWBs to compare practices’ performance,
allowing them to see where they could perform better, leading to fresh, innovative
ideas.
•
The tool will also allow practices, emerging CCGs, current PCT clusters and (in future)
the NHS Commissioning Board to link the data to wider information on healthcare
need, activity and outcomes.
•
Development of the GP practice comparative tool will be in 3 stages:
- Stage 1 (June 2012), will enable practice data to be viewed in a time series format
along with a number of chart styles and tabular forms.
- Stage 2 (September 2012) will have greater functionality allowing users to ‘save’
data selections and customisation of ‘standard views’.
- Stage 3 (delivery date to be confirmed) will permit correlation, multivariate or
other statistical analysis of the indicator or underlying data.
Transparency
•
The comparative tool, focuses on 2 areas:
- continuing work to identify other relevant clinical data indicators
- developing composite and aggregate data indicators
•
New data items
- Working to publish 25 new data indicators in June 2012, these include A & E and
readmissions data, life expectancy, contract type and weighted patient list size.
- Further indicator development will take place over the next 18 months with data
indicators published on a quarterly basis and when ready.
•
Composite indicators
- Bring together individual indicators into a single index, allowing simpler and quicker
comparisons to be drawn.
- Expert groups have been formed to initially advise on 3 areas: Diabetes, Prescribing
and Patient Experience.
- Initial release of the Patient Experience will take place in June and cover 5 domains:
accessing care, waiting to be seen, opening hours, consultations with a doctor and
consultations with a nurse.
GP Patient data
Expanding the offering
Adding additional data to the
Indicator Portal
Launching a tool to accompany the
Indicator Portal that will enable
users to manipulate almost 300
different datasets
Continuing to release new data into
the systems
Surfacing all the data in a single file
to help 3rd parties use the data to
build their own tools
2. NHS Operating Framework 2012/13
Indicator PHF10
Percentage of patients with electronic
access to their medical records
The current collection – SRF14 % of patients
with greater control of their medical records
• During 2011-12 NHS Connecting for Health collected data
at PCT level for SRF14:
– % PCT’s providing patients access to booking
appointments, repeat prescriptions and their medical
records broken down by:
• no functionality available;
• functionality available but not in use;
• functionality available and being used.
The planned collection – PHF10: % of patients
with electronic access to their medical records
• The new indicator PHF10 will require data to be collected
at GP Practice level by the HSCIC:
- GP practices providing patients access to booking
appointments, repeat prescriptions and their medical
records broken down by:
• no functionality in place;
• functionality available;
• functionality in place and being used:
– Number of times patients have accessed their records.
How?
• GP System suppliers collect data quarterly for a return to
the HSCIC
• HSCIC transforms data to DH specifications
• Data is submitted to DH
• HSCIC / DH publish data relating to % patients by GP
Practice with electronic access to their medical records.
When?
• 1st data collection by GP System suppliers for PHF10 30th
June 2012
• Data from system suppliers to HSCIC by 16th July 2012
• Reports to DH by August 2012
• Reports quarterly thereafter
3. Prescribing data
Why release the data?
• Plan for Growth: “ … will look to publish
prescribing data at practice level, subject to an
evaluation and impact assessment by the NHS
Information Centre.”
• Transparency agenda: “Open data must
become the organising principle of public
services.”
• PM letter to Cabinet, July 2011, restated the
commitment to make available "prescribing data
by GP practice by December 2011".
What has been released?
….over 4 million lines of data….
• For each practice in England, and for each
dispensed medicine (by chemical name),
dressings and appliances (at section level) …
– Total number of items that were prescribed and then
dispensed.
– Net Ingredient Cost.
– Actual Cost.
• Supporting detail: FAQs, sample data, glossary
What has been released?
• Data for September 2011 released on 14
December 2011.
• One very large CSV file with practices identified
only by national code.
• Supplementary file of practice codes, names
and addresses.
• October 2011 released in January 2012, and
so on …
4. Pathology
Background
• Every year GPs request 500m pathology tests (37 m
reports)
• The results are all routed from laboratories via secure
electronic messages to practices
• The results all pass through a central electronic ‘sorting
office’ – the Data Transfer Service (DTS)
• The national Pathology Benchmarking project (Universities
of Keele and Leeds) has taken a pseudonymised copy of
the data for 2 weeks to analyse the quality of the data and
to undertake a number of analyses, initially concerned with
quality of Read coding and units of measurement used
What the HSCIC propose to do
• Examine the costs, benefits and security /
confidentiality issues of creating a national
pathology database for GP requested pathology
by copying the data as it flows from laboratories
through the DTS to practices
• Seek sponsorship and ethical approval to build
such a database and make results available in a
secure / pseudonymised manner
• Build the database and consider further
applications e.g. hospital requested pathology
data
Potential uses of pathology data
• Analyse patterns of GP use of pathology services;
evidence from Keele has shown that if data is exposed, it
can encourage laboratories to improve the data quality
and GPs to modify their requesting behaviour.
• To support pathology modernisation (Turner report), and
the commissioning and contracting for lab services by
commissioners.
• Ensure that NICE guidelines are followed regarding the
use of pathology testing. For example are tests ordered
too late? Or ordered too early to be of any value?
5. MIQUEST query service
MIQUEST query service
• Required from 1st April 2012:
– to immediately be able to support the QOF pilot process
– to immediately be able to support the National Diabetes Audit
– To have the capacity to support other identified monitoring
programmes as they are confirmed.
– DH in collaboration with the Health Protection Agency collects
vaccine uptake data for various vaccines from GP practices,
including Seasonal Influenza, Pandemic Influenza and
Pneumococcal Polysaccharide Vaccine (PPV). These data are
collected via the ImmForm website and are made available to the
HSCIC for publication.
MIQUEST query service
• GPES is intended to replace the MIQUEST
authoring service once fully operational in
2013/14.
• Anticipated that the MIQUEST authoring service
will be required for 2 years from 1st April 2012,
with option to extend for a further 12 months.
• HSCIC have informed the preferred bidder
6. MIQUEST ownership and future
MIQUEST components
• MIQUEST Standard Specification
• Enquirer software
• GP System Interpreters
MIQUEST Process
MIQUEST
Usually local
enquirer but
may be
national
Define plain
English data
requirement
Code clusters
and logical
rules and write
HQL query
Run matching
queries
on n
OUTPUT
GP systems
Data
extracted
in standard
format
Current and short-term landscape
• GPES meets the needs of national DH sponsored
enquirers
• GP suppliers offer in house data supply to their
customers, e.g. EMIS IQ (+/- GPES)
• Commercial third parties have extraction
solutions working via system APIs (pre-configured
queries)
• MIQUEST or replacement remains the only
flexible, low cost, in-house mixed system option
for small/local health (e.g. CCG) and academic
organisations
Options for the future
1. Kill off MIQUEST and do not replace
2. Continue current development of MIQUEST
3. Increase development of MIQUEST to meet future needs
In parallel new development by the HSCIC may:
4. Make use of and adapt new technology and systems
developed for GPES and GP system suppliers to provide a
system that meets the long term requirements
5. Develop an entirely new data extraction system suitable for
local data extractions
7. Education, Training and Development
Data Quality Assurance within the HSCIC
Background
• Health & Social Care Act confirms the HSCIC
role is to ‘provide an assessment of the quality of
health and social care information and publish
that assessment’
Data Quality Assurance Project
Short to Medium Term
– Reporting – visible, transparent and published with an Interim
Report published June 2012
– Assurance Framework (identify, monitor, report, improve) to be
consistently applied across activities within HSCIC
Longer Term
– National developed framework which outlines expectations
(Standards) for local data providers, measures compliance
(Assurance) and incentivise change (Improvement)
– Over time, the HSCIC will seek to positively influence and raise
data quality standards at the point of data recording by providers
through the above.
– Needs co-operation of other organisations, local and national, to
deliver framework (e.g. NHS CB will set standards and incentivise
improvement through contracts)
Data Quality Assurance Project
To ensure the Data Quality Framework is successfully
implemented, we are engaging with:
•
•
•
All key national stakeholders (e.g. NCB, Monitor, DH,
CQC, CFH, NICE, PHE)
NHS, social care professional, clinician and organisation
consultation and involvement in developments
Key business areas within the HSCIC who currently
undertake DQA activities
Primary Care ETD
• The HSCIC is assessing the needs of primary care providers
for the provision of data quality training
• Data Quality training for primary care was previously
provided through the PRIMIS + contract with Nottingham
University
• With the introduction of Clinical Commissioning Groups
(CCGs) in the Health and Social Care Act the structure of
the provision of data quality training in Primary Care needs
to be revised to reflect the new NHS environment
8. GPES
GPES - background
• Centrally managed extraction and analysis service that will
obtain information from NHS GP systems in England with
the aim of improving patient care.
• GPES will be used by HSCIC to provide extracts of data
from GP clinical systems on behalf of specified and
approved organisations that have Department of Health
sponsorship.
• Comprehensive and rigorous approval process for all
requests for information .
• Only data needed to accomplish the approved purposes
will be extracted.
GPES - update
• Currently in development .
• Potential GPES customers will be required to undergo an
approvals process to use the service, demonstrating how
they plan to use the data they have requested and how
that data will be used to provide benefits and improved
care and outcomes for patients.
• Information Governance Principles
• Independent Advisory Group
GPES Independent Advisory Group (GPES IAG)
The GPES IAG will:
GPES IAG membership:
•
Chair
HSIC prepares
“IAG pack” for GPES IAG’s
consideration, including:
• Customer requirement
• IG assessment
• Benefits plan
•
Lay
member
GP
(BMA)
•
GPES
IAG
Lay
member
GP
(RCGP)
Consider the HSCIC’s IG
assessment
weigh risks and benefits to
decide whether, in its view,
the extraction is appropriate
and in the public interest.
Make a recommendation to
the HSCIC
Recommend further consideration
or significant changes
Lay
member
GP
(PHCSG)
GPES IAG can draw on
advice from HSICIC
Non-GP
(PHCSG)
HSCIC IG
assessor
Recommend minor changes
Recommendation to proceed
(subject to further approvals)
Academic
Ethicist
Secretariat
(HSCIC)
Recommendation to proceed
GPES – GP Practice next steps
including:
– Involvement in detailed design, testing and assurance
of GP Practice related functions and screens
– Involvement in design and development of patient
related communications materials
– Targeted communications - including GP Practice Bimonthly Newsletter
– Training – GP Practice related material assurance,
testing and delivery approach and timetable
– Deployment – GP Practice First of Type and rollout
approach and timetable
– Live service readiness activities:
• GP Practice preparation and,
• Operational support processes
EMIS’ Solution for GPES
EMIS
reporting
Service
C
LV
PCS
C
C
EMIS
central
hosting
services
EMIS
Fam/We
b
GPES
Extract
server
C
GPES IG
Principles
C
18
Thank you