Dr Bob Milne

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Dr Bob MilneMBChB, FRCGP

• SPICE Background and Context

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Dr Bob MilneMBChB, FRCGP

• General Practitioner, Cults, Aberdeen
• Medical Director, PCCIU (Primary Care Clinical
  Informatics Unit)
• Chair of SCIMP

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Scotland Health Data Collected since 1922..

• Maternity
• Birth
• Neonatal
• Child-health surveillance
• Immunisation
• GP appointments
• Dental appointments
• Outpatients

• AE
• Hospital Admissions
• Prescribing
• Screening
• Cancer Registration
• Cancer Treatment
• Community Care
• Death

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Primary Care Clinical Informatics UnitUniversity
of Aberdeen

• What has PCCIU done so far?
• What does PCCIU do now?
• Associated Research

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My First?
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What has PCCIU done so far (1)?

• Since 1988 has collected and collated data from
  Scottish General Practice producing a variety of
  feedback and other reports
• Thank you to all
• participating practices
• collaborating organisations
• e.g. SEHD, ISD, SCIEH/HPS, CRAG/QIS, RCGP

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What has PCCIU done so far (2)?

• PCCIU aims to improve clinical management of
  individual patients and planning for population
  care by more effective information management of
  data about patients, target populations and
  localities.
• PCCIU aims to encourage practitioners to use
  their computers more effectively by optimising
  data entry, clinical utility and reporting
  effectiveness, on the basis that these elements
  contribute directly towards improving patient
  care.

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What has PCCIU done so far (3)?

• Programmes
• Electronic Questionnaire (EQ) Analyse, Extract,
  PAT
• Practice Health Profile (GHB)
• Continuous Morbidity Recording (CMR)
• now Practice Team Information (PTI), ISD
• Weekly Reporting Service (GHB)
• Practice Analysis Tool (PAT)
• General Practice Health Bulletin
• Scottish Programme for Implementing Clinical
  Effectiveness in Primary Care (SPICE)
• - with RCGP and others.

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Anonymised, secure dataconfidentiality,
security, data protection

• Patient data anonymised no name, truncated
  d.o.b. and post code
• Practices consent numeric identifiers
• for patient data linkage
• Transfer data
• compressed and encrypted
• chopped up (for email attachment)
• Stand-alone, MTS
• Standard operating procedures
• Physical security
• Information security (e.g. only 1 practice in an
  LHCC report)

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RCGP Scotland , 1988

• Clinical Effectiveness Programme (CEP)
• SPICE-pc and Practice Accreditation (PA)
• Scottish Programme for Improvement of Clinical
  Effectiveness Primary Care
• now
• SPICE

SPICE-pc criteria documentation sets data
capture screens data collection and
feedback benchmarking reports
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What does PCCIU do now?

• SPICE
• Translate clinical criteria into the
  technically feasible
• Develop data entry requirements
• Develop data entry templates (GPASS what about
  the others?)
• Create data extraction tool (Extract!) inc. MTS
• Develop data transfer methods paper, floppy
  disk, email
• Import to PCCIU databases
• Reports
• feedback, comparative reports - practice, (L)CHP,
  regional, national
• consented practice identified e.g LHCC
• in practice patient identified e.g. finding
  research subjects

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SPICE Clinical Topics
Hypertension Ischaemic heart disease Leg
ulcers Diabetes Mental health Dose critical
medication Left-ventricular dysfunction
Hypothyroidism Asthma Epilepsy in adults
Pernicious anaemia Stroke/TIA
Acute Back Pain Contraception Menopause inc.
HRT Rheumatoid Arthritis Smoking
Cessation COPD Mental Health Cancer STD
(Chlamydia) Postnatal depression Osteoporosis
Dyspepsia Incontinence
From 2003 nGMS CHD LVD Stroke/TIA Hypertension Di
abetes COPD Epilepsy Hypothyroid Cancer Mental
Health Asthma Laboratory Results Exception
codes Minor Surgery Influenza Enhanced Services
Warfarin (modify existing) Drug
Monitoring IUCD etc.
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Sample of Criteria Lists

• Management of Asthma
• The criteria contained in this report were
  developed in collaboration with the Scottish
  Asthma Management Initiative (SAMI)
• Criteria
• The practice should maintain a database of
  patients with active asthma. Patients who have
  neither received a prescription for asthma
  therapy, nor attended with an asthma-related
  problem (excluding routine review) in the last
  two years, should be considered inactive after
  review by a member of the Primary Care Team.
• Patients on the active asthma database will be
  offered review at least annually and there is a
  mechanism to identify defaulters.
• The patient's current therapy will be recorded.
• Symptom control in the month prior to each review
  visit will be assessed using the RCP "three
  questions"
• Peak flow will be recorded at every review visit
  and compared to patient's best peak flow.
• Height should be measured once in adults.
• Children's height should be measured at least
  annually.
• The number of unscheduled asthma related
  health-care contacts (hospital admissions, AE
  attendances, use of out-of-hours service,
  non-routine practice consultations) since the
  last visit will be recorded.
• Patients will have a written self-management
  plan.
• Asthma management discussed at review
• Compliance and use of therapy in context of
  symptom control will be discussed.
• Inhaler technique will be assessed if not
  previously conformed and advice offered.
• Smoking status will be recorded and smokers will
  be advised on quitting mechanisms.
• Trigger factors and their avoidance will be
  discussed.
• Influenza vaccine will be offered in line with
  national guidelines
• Pneumococcal vaccine will be offered in line with
  national guidelines.

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Example SPICE incorporating QOF
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SPICE Reports
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Reports header
Reports footer
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Reports body
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Reports chart
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Reports special
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Complementary datasets

• SPICE/PCCIU
• Weight, height and BMI prescribing
• CMR/PTI
• Read codes overweight and obesity

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Associated Research

• PCCIU-R
• Dr Colin Simpson
• Institute of Applied Health Sciences
• Steering Group
• Perceived problems
• Lack of recognition of database-based research
• International ignorance of universal patient
  registration
• Pragmatic epidemiology

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Research Outputs

• Publication areas
• Primary Care computerisation
• Large Datasets methods, quality
• Health Promotion
• Respiratory Disease
• Pharmacoepidemiology
• Autoimmune disease
• Cardiovascular Disease angina, CHD, heart
  failure
• Epidemiology of allergy
• Stroke

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What next?

• Revise and develop SPICE
• Engage non-GPASS systems as well as GPASS
• Develop reporting
• Shift of databases, on-line working
• Research (e.g. GPRD Vision 18 in Scotland)
• Linkage between data sets (eg PTI with hospital
  activity data)
• Wider use of data held within PCCIU?

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Thats all folks!
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