Data Collection in IAPT
The IAPT data standard
Margaret Oates IAPT National Programme
Nick Bridges NHS Information Centre
Relieving distress, transforming lives
Version 3
Introduction
• Background/update
– Data collection Principles
– Update as at September 2011
• New processes for central data collection and
reporting
– The data standard
– The central data repository
– Data submission process
• Maintenance
• Inputs/ Outputs from the system
– Work-in-progress
• Next steps &Timeline
– Testing continuing. Submissions commence November 2011.
Mandated from April 2012
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Central Principles for data
collection
• Data collection is an integral part of delivering IAPT
services
• Use a combination of patient-centred interviewing and
outcome measurement tools
• Effective communication with patients
• Patient involvement in decision making
• Provides tangible evidence of treatment progression
• Effective inter-professional communication
• Used by supervisors to review clinical work
Central Principles for data
collection
• This primary use of data helps to Improve the quality
of clinical interventions
• The IAPT toolkit first published in 2008 started to set
out a common data set or clinical record
• IAPT data handbook provides guidance in data
collection and the use of data
• Used by managers and commissioners to facilitate
effective service performance
• Including monitoring monitoring equity of access and
provision of NICE approved treatments
Update as at September 2011
• Services continue to collect IAPT data set
– KPIs via Omnibus, guidance for 2011/12 at http://www.iapt.nhs.uk
– Q1 will be published for the first time on NHS Information Centre web site
(precise location to be finalised)
• Information Standards Board (ISB) approval achieved in March
2011
– IAPT data set approved as an National Operational Standard in April 2011.
Sets out how we will utilise IAPT data for secondary uses
– Information Standard Notice (ISN) and IAPT Data Handbook issued
– National Data Standard mandated from April 2012
– Development of the IAPT central data collection system in-progress
• Data Standard Implementation project set up, co-working with
NHS IC
– Overseeing development of National processing and reporting system
– From April 2012 the way we collect and report IAPT data will change!
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Focus of today
• The New IAPT data standard
• How it will be implemented in practice
• Changes to process and data flow
• Set expectations and provide a clear timeframe for
development
Information Standard
• What do we mean by ‘Information Standard’?
– Output data standard
– Data items/ permissible values
– Mechanism for end-to-end processing
• Approval gained:
– Information Standard Board (ISB)
– Review of Central Returns
– National information Governance Board
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NIGB & Patient Identifiable Data
• Patient identifiable data will flow centrally, however reports will be
aggregated and it will not be possible to identify a patient from the
reports.
• S251 application approved meaning no need to seek explicit consent
to use patient data.
• However, it is a legal responsibility to inform patients that their data
will be used for secondary purposes, and for this reason the NIGB
has asked us to provide patient’s with an explanatory leaflet and
allow patients to ‘opt out’ from national reporting.
• The Programme has included an example leaflet in the new data
handbook, this may be printed and distributed to patients.
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Changes since the MDS/Clinical
record?
•Additional items
- Compliance with Equality Act, and
- Policy development (e.g. veterans)
• Changes to existing items in line with
- NHS Data Dictionary
- Definitional testing
• Local flexibility to collect additional data items
• Formal change and testing processes
- Future updates likely after April 2012
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Development of the IAPT central
data collection system
• Development of the IAPT central data collection system is near
completion.
• Early system testing complete, currently conducting user testing.
• The system is expected to go-live on 7 November 2011 to receive
October data.
• From this time services are encouraged to submit data extracts.
This will help to test out processes and embed into practice in
readiness for mandation in April 2012.
• It is important to emphasize that the provision of a patient-level
reporting system will have significant impact on local information
management practices
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Change to process
• Every IAPT service will be expected to submit a full
data extract to the central data collection system on a
monthly basis.
• 2011/12 is a transition year when services can make
arrangements to change local IT systems and put in
place procedures to process data.
• 2012/13 reporting via the IC website with parallel
running of KPIs until assured of data quality from the
new system
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How will the data standard support
the IAPT Programme?
• Consistent framework for data collection and central reporting
• In-line with wider Information Strategy ‘Fundamental review of
data returns’
• The provision of a central reporting system will allow secondary
reporting and help us to better commission and manage services.
• IAPT national reports will be published on the NHS IC web site to
support monitoring against IAPT quality standards including;
equity of access, patterns of interventions and outcomes
• Allow benchmarking and make information accessible and
transparent in a way that allows patients and the public to
compare the range of interventions and outcomes achieved
across services
• Local data quality reports available to help improve data quality
Data Structure and Data
Flow
The Data Set and Submission
• 50 data items (actually 53 as can have up to 4 therapy
types)
• Data items grouped
– Patient table
– Disability table
– Referral table
– Appointment table
• Defined permissible values
• Defined validation rules which will lead to either warnings
or failures
• Submitted as the IAPT Intermediate database (IDB)
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Data storage
• Patient identifiable data is submitted to the
Bureau Service Portal. Its then
– Processed
– Held for a short period to allow local download
– Deleted
• The Bureau Service Portal is not a data
warehousing service
What data is held ?
• The Bureau Service Portal will retain only five extracts at
any time:
– the most recent primary and refresh submissions
– the submissions from the previous fixed period
– the primary submission from the period before that
• For example:
– March primary ----- most recent submission
– February refresh ----- most recent submission
• Plus
– February primary
– January refresh
– January primary
Amendments since initial issue
of ISN
• Removal of default W code from all outcome
measures. No default code should exist for the
outcome measures included.
• PHQ-9 – Alignment with PHQ-9 collection within
MHMDS. Correction to ensure consistency of
collection.
• Removal of attended or did not attend code ‘0 – Not
applicable, appointment occurs in the future’. No
requirement exists to connect future appointments.
• Generalized Anxiety Disorder Penn State Worry
Questionnaire score range is incorrectly shown.
Amended to cover the range 16-80.
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Amendments since initial issue
of ISN
• Renamed British Armed Forces Indicator to Ex-British
Armed forces indicator
• Removed from Ex-British Armed forces indicator codes ‘01
– Yes, currently serving (including reservists)’ and ’04 Dependant of current serving member’. Both removed as
serving personnel are not seen by IAPT services.
• Addition of default codes:
– Ethnic Category
– Sexual Orientation
– Org Code of Commissioner
– Appointment Purpose
– Employment Support Indicated
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The intermediate database (IDB)
•
•
•
•
4 tables
Microsoft Access format
Defined structure which cannot be changed
Support for all versions of Access since
2002
• Must not remove tables or amend structure
of IDB as will lead to a rejection
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Collation of IDB
• Local data collection and validation
• Data extraction from local system(s)
• Format into required 4 table structure
within an Access database, the IDB
• What data should be included ?
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Construction of IDB
• Inclusion rules are:
– Referrals either opened in the period or already
open at the start of the period
– Appointments linked to those referrals
– Patients associated with those referrals
– Disabilities associated with those patients
• It may be that not all referrals have appointments
and not all patients have disabilities
• Rules are described in a separate document
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Submission
• Submitted via Bureau Service Portal, provided by
Systems and Service Delivery Team of Connecting for
Health
• Currently requires a N3 connection, but investigations
are underway to determine if an alternative exists
• Requires organisation code provided by ODS service
• Requires username and password to access
– Approval granted by local Caldicott Guardian
– ‘Application form’ available from Connecting for
Health (link later)
• Monthly submission of primary and refresh
submissions
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Fixed period processing
• At any point in time the BSP will expect data
sets to be submitted relating to a specific period
of time.
• For instance April’s data set will expect to be
submitted in May.
• If March’s data set was submitted in May it
would be processed as if it was April’s data,
something which clearly should be avoided.
• A window of time exists in which a submission
can be made – if it’s missed no option exists for
later submission
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‘Not for submission’
• It may be that a situation arises whereby a data
set needs to be run through the submission
process for testing purposes.
• This is called a ‘not for submission’ submission.
A user defined reporting period is able to be
selected.
• The data set will not progress fully through the
processing system and will not be used for
national reporting.
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Submission and processing
timescales
• Using April 2012 as an example….
Window
opens
Window
closes
Closed for
processing
Processed data
set available
07/05/12
25/05/12
w/c 28/5/12
04/06/12
• Window always opens on a Monday and closes on Friday. Open
between 3 and 4 weeks, depending upon calendar for that month.
• Always closed for a week
• Data set available by the following Monday, the same day window
reopens for next months submission
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Bureau Service Portal
• In development
• Plan is for portal to be in place from 7 November
2011 for voluntary submission
• Process will essentially be:
–
–
–
–
–
–
–
Login
Upload
Monitor
Retrieve data quality feedback and data downloads
Resubmit as required prior to window closing
Once window closes final data processing begins
Download processed data set for use locally by IAPT
providers, commissioners and the NHS IC
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Data quality reports
• Data quality reports will be supplied following submission
• The data set will be subject to a series of validations to
test its integrity prior to it undergoing further processing
• Validations can lead either to
– A warning
– A failure
• A failure means the whole data set must be resubmitted
• A warning means the data should be amended, but
processing can progress if it is not
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Validations - Examples
Warnings
• NHS number status indicator code is null when a
NHS number is provided
• General medical practice code does not match a
valid ODS code
Failures
• Local patient ID is null in any of the 4 IDB tables
• Any date is not in valid format
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Processing stages
Pre deadline processing
• Various derivations which only utilise data
present within the current periods submission,
such as age at referral.
Post deadline processing
• Various derivations which utilise data from one
or more reporting period submissions, such as
IAPT person ID (used to track patients across
providers and submissions) and PHQ-9 first and
last scores.
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Example:
Submission period is April
Pre deadline
April activity
Derivations such as age at start of reporting period, county,
PCT of residence
Post deadline
February activity
March activity
April activity
Derivations such as First and Last score patient health
questionnaire scores, First and Last social phobia inventory
scores, Count of number of pure self help sessions
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Retrieving data sets
• A user must login to the portal to retrieve a data set after
it is processed
• An email notification is sent to registered users once
data set processing is complete
• Whilst the submission window is open a ‘pre deadline’
data set is made available following each submission.
This allows for instance data quality checking. Made
available only to providers.
• Once the submission window closes ‘post deadline’ data
set is made available. This is the final data set used for
reporting purposes. Made available to providers,
commissioners and NHS IC.
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Who receives data sets?
Pseudonymised data set
(non identifiable)
Patient identifiable data
set
IAPT commissioners
NHS Information Centre
IAPT providers
• IAPT providers only receive data related to the patients
they have treated
• IAPT commissioners only receive data related to the
patients for whom they have commissioned a service
• The NHS Information Centre receives data for all patients
seen by all providers
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Maintenance and future
changes
Maintenance and possible new items
• All changes will be overseen by the IAPT Outcomes and Informatics
Board
• Protected characteristics detailed in the 2010 Equalities Act 2010 i.e
Marriage/civil partnership, Gender reassignment, Pregnancy,
maternity
• Inclusion of scores to describe the results from a Patient Experience
Questionnaire.
• Revision to 'Sexual Orientation' data item value list. Code ’02 –
Homosexual’ to be renamed to ’02 - Gay/Lesbian’.
• Items to Support Payment by Results
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Future Reporting
Future Reporting
• The Information Centre is commissioned to
produce national reports
• Initially will be limited to data quality reports
• From April 2012 more extensive reporting
against IAPT quality standards
• Standard reports currently being defined
• Parallel running of the new system and KPI’s
throughout 2012
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Next Steps and Timeline
Next steps
• Disseminate literature and guidance
• Check with local system suppliers
• Ensure resource in place to process/validate
data
• Request the Intermediate Database
• Apply for access to the Bureau Service
Portal
• ‘State of Readiness’ checklist
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Planned timescale
Date
Event
End September /
early October
Issue of revised ISN and Standard Specification
document
October
Complete system testing
7 November
Portal go-live
November – March
Services submit data on a voluntary basis
November – March
Services use data extracts and diagnostic reports to
improve data quality
April 2012
Data submission mandated
From April 2012
Parallel running of both KPI and data set reporting
systems
From April 2012
National reports will start to be published on the IC
website
From April 2012
Establish user network
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Further information
• To obtain the Intermediate database (IDB) email
enquiries@ic.nhs.uk
• Register your interest to receive further information on
the data set at
http://www.ic.nhs.uk/iapt
• Email queries to
iapt@ic.nhs.uk
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Further information
• Bureau Service Portal access application forms
http://www.connectingforhealth.nhs.uk/systemsan
dservices/ssd/prodserv/vaprodopenexe
1 – ‘Download the Caldicott Guardian Certificate’
Then at least one week later
2 – ‘Download the Bureau Service Portal Data User
Certificate’
• Information Standards Board – IAPT Specification
document
http://www.isb.nhs.uk/documents/isb-1520/amd-51-2010/index_html
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Questions, queries,
uncertainties ?