Secondary Uses Service

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Secondary Uses Service

• Presented by
• .
• SUS Project Team
• (Date) 2006 (v0.79)

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Event Administration / Housekeeping

• Fire alarm, exits etc
• Toilets
• Breaks - drink
• Start and end time
• Mobile phones
• Evaluation presentations

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SUS Superuser Training 2006A/B Part 1
Agenda

• Introductions
• Background, SUS benefits
• SUS developments current releases
• Information governance
• Access controls pseudonymisation
• SUS practical Issues
• Questions and answers

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Who questions

• Who are we?

• Who are you?

• Handling questions
• In section breaks
• And at end of presentation
• Will gather outstanding and unanswered questions

• Reference material - see SUS website
  www.connectingforhealth.nhs.uk/sus/whatsnew/

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Objectives

• By the end of this session you will be able to
• Understand why and how the Secondary Uses Service
  (SUS) is being developed and what SUS is
• Have an awareness of the benefits SUS will
  provide
• Recognise differences between SUS and NWCS
• Appreciate the rules and regulations surrounding
  SUS
• Understand what you can do with SUS and its data
• Know how to contribute to SUSs development

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Background to SUS

• Secondary Uses Services

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Context for SUS - 1

• NHS Plan
• Patient centred NHS
• Cradle to grave care
• Wanless Report
• Change agenda
• policy, process organisation,
• care delivery
• augmented by specific initiatives
• Performance management - targets

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Context for SUS - 2

• Investment in IT to support change agenda
• Connecting for Health, Care Records Service -
  ensuring facilities are available for all
  organisations
• National support for major initiatives - Payment
  by Results (PbR), Practice Based Commissioning
  (PBC), 18 week waits, etc
• Increasing concern about individual privacy -
  Care Record Guarantee, Confidentiality

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Patients the NHS
Staff Actions
And lots more
Information Facilities
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NHS Care Records Service

• A single electronic health care record for every
  individual in England
• life-long history of patients health and care
  information (regardless of where,
  when and by whom they were treated)
• providing healthcare professionals with immediate
  access to medical records and care notes 24/ 7
• secure access and audit trails

• supporting the NHS to collect and analyse
  information, monitor health trends and to make
  the best use of clinical and other resources

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Questions, questions,
Are services effective? Can services to patients
be improved?
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Using information
Use of Information
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Secondary Uses Service

• The central repository of health data for purpose
  of making secondary uses of the data
• Most data to be collected or derived from
  clinical systems as a by-product of direct care
  (ie primary use)
• SUS has all NHS related activity and other
  non-patient record based data
• To provide the tools and services for an
  effective and secure working environment for
  analysis and reporting
• Mainly coded data

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Applications (Actual Possible)

• Payment by Results - tariff-based reimbursement
• Access and Choice -
• Commissioning, capacity and demand, total waits
• PBC, 18 week waits
• Benchmarking and comparative performance
• Public health - Screening, surveillance,
  epidemiology
• Patient safety - Longitudinal studies, adverse
  drug reactions
• Research and Development - Effectiveness, outcomes

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Components of a secondary uses service
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Structure of SUS Architecture
Manage Metadata Technical / Business
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SUS Analysis Potential

• Secondary Uses Services

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Building the SUS Warehouse Stage 1

• ANALYSIS
• Comparative provider performance
• Length of stay by case mix, admission method,
  discharge destination etc.
• Readmissions
• Outpatient / AE conversion rates
• Outpatient follow up ratios

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Building the SUS Warehouse Stage 2

• ANALYSIS POTENTIAL
• Population Level Linkage
• Practice / Area
• Access / incidence rates
• Prevalence rates (for QOF conditions) compared
  with service access / use
• Age Standardisation etc.
• Simple geographical analysis

Population Data
Quality Outcome Framework
Practice / Area Profiles
Person Level Data

• PERSON DETAILS
• DoB, Gender
• Address
• Registration

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Building the SUS Warehouse Stage 3

• ANALYSIS POTENTIAL
• Linkage at person level
• Additional elective care analysis
• Patient choices and elapse times for treatment
• Additional analysis of some national audit
  datasets
• More advanced geographical analysis

Population Data
QOF
Practice / Area Profiles
Person Level Data

• PERSON DETAILS
• D o B, Gender
• Address
• Registration

• CARE SPELLS
• Admitted patient care
• spells within a single
• provider
• Costed at tariff
• National Audit spells

• CARE EVENTS
• Booked appointments
• Admitted patient care
• episodes
• Outpatients
• AE attendances
• National Audits

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Building the SUS Warehouse Stage 4

• ANALYSIS POTENTIAL
• Comprehensive linkage at person level
• Prescribing effectiveness
• Link chronic condition, drugs dispensed,
  treatment spells
• Assessment and treatment elapse times
• Overall cost profiles
• Cohort identification and analysis
• Additional analysis filtered by area population
  characteristics
• Complex geographical analysis

Population Data
Practice / Area Demographic Profiles
QOF
Area Population Characteristics
Person Level Data

• PERSON DETAILS
• D o B, Gender
• Address
• Registration

• PERSON
• CHARACTERISTICS
• Chronic conditions
• Risk factors

• CARE SPELLS
• Admitted patient care
• spells within a single
• provider
• Costed at tariff
• Pathway construction
• Repeat dispensing
• Prescriptions
• National audit spells

• CARE EVENTS
• Booked appointments
• Prescriptions
• Admitted patient care
• episodes
• Outpatients
• AE attendances
• National audits

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Potential Benefits of SUS - information

• Benefits will come from the ways use is made of
• Consistent data collection across the country
• Comprehensive coverage of all NHS-commissioned
  care
• Cohesive information collection enabling linkage
  of patient data from different sources
• Currency of data, collected quickly from local
  sources
• Confidentiality - secure environment to hold
  patient data
• Common approaches to the derivation of data, and
  hence consistency of analysis
• Cranking the handle move to focus on use of
  information

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Potential Benefits of SUS - wider
Capturing and understanding the patient journey

• Supporting implementation of policy and reform
• Definitive source of PbR activity
• Supporting patient choice
• Supporting improvements in quality of care
• More effective use of resources
• Providing better evidence on which to base policy

Improved/more data and facilities forResearch
Public Health
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SUS Development Stages Current Releases

• Secondary Uses Services

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Stage 0PbR Managed Service
No user access to data marts
Mail boxes accessed by specific users who are
registered separately for this service
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Stage 0.5PbR Managed Service plus PbR on
line reporting service
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Stage 1PbR and NWCS replacement services
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Current Releases 2006 A B-1

• Objectives
• To support PbR
• To replace, but not replicate, NWCS
• Give base for future developments
• Give basis for reducing use of patient
  identifiable data

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2006-A B-1

• Components
• PbR Mart - 06A managed service, 06B on-line
  service
• Extract Mart - to provide
• On-line service with RBAC implementation
• Tracker, DQR eDQRS
• Pseudonymised data
• Continuing batch service for production of
  routine extracts

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Getting here

• Original NCRS Specification for SUS
• Elaboration involving NHS staff
• System development by NASP against CfH contracts
  and methodologies
• Warehouse development
• Data loading and checking
• Formal testing of products - modules
  integration
• Experience of earlier releases
• User Assurance of products, Look Feel
  workshop
• Phased roll-out feedback

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Contents

• CDS types - APC, OP, AE
• PbR requirements - spells, HRGs, tariff
  application
• Include derived fields, and unique record id
• Separate extract of Very General Purpose fields -
  for IG reasons
• Details of interchange processing and data
  warehouse updates by CDS type and Provider
  submitting
• One financial year and year to date activity

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Facilities

• Provider and PCT views (responsible and resident)
• Support shared service views
• Clear and pseudonymised views with Role Based
  Access Controls (RBAC)
• SHA Views
• Enable introduction of new datasets
• User defined control parameters, no need for NHS
  Value Added Service (VAS) Extracts

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Data Quality

• NHS Data Quality rules fully applied
• Interchange level acceptance/rejection
• Localised issues on data and interactions with
  SUS
• XML feeds will provide early data quality checks

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Importance of 06A 06B Releases

• NWCS terminates 31 Dec 2006
• SUS will be source of definitive PbR data
• SUS warehouse provides basis to use CDS derived
  data for supporting other national initiatives in
  near future
• Enabling demonstrable improvement in data quality
  and reduced loss of data

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HES - NWCS and SUS

• HES (Hospital Episode Statistics)
• HES provides basis for official stats has
  additional data quality work undertaken widely
  used with HESid
• Source - extract from NWCS, processed by
  Northgate
• HES -
• Will be sourced from SUS - extracts proven
• Continue to operate in same way till contract
  ends
• Expected to become SUS HES Mart

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Differences Between NWCS and SUS Design
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2007 SUS Releases

• Early 2007
• revised PbR algorithm
• Mid 2007
• New NHS data schema - version 6
• HES Enhancements
• Critical care MDS
• Late 2007
• NCASP Clinical audits - diabetes, etc
• Policy/initiative support

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Information Governance of SUS

• Secondary Uses Services

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SUS Information Governance

• CDS processing uses patient identifiable data -
  eg NHS Number - no clear basis in law
• Laws - Data Protection, Common Law duty on
  confidentiality, Health Social Care Act 2001
• Policy - CRG Confidentiality
• SUS needs secure basis to operate
• SUS provides the means to reduce the use of
  patient identifiable data outside the NHS

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SUS Information Governance

• Application to Patient Information Advisory Group
  (PIAG) to store process patient identifiable
  data
• Interim approval with conditions
• Section 60 application approved for 12 months
  whilst pursuing
• Specific regulations or
• Primary legislation
• Reason - potential scope breadth of SUS huge,
  wider debate proper legal basis needed

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SUS Case for S60

• Business continuity - existing systems,
  difficulty of moving to pseudo data
• Other facilities needed to enable end of clear
  data extracts
• SUS needs to be established in providing basic
  services data quality to prove feasibility
  develop user confidence
• Has potential to improve IG in NHS
• SUS provides exit strategy for many S60
  approvals, but facilities need developing

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PIAG Conditions - 1

• For established CDS only
• For health service purposes only
• If beyond June 07, new application
• Minimise number of users
• Use anonymised / pseudonymised data wherever
  possible
• Appropriate access controls
• Shared services supported if suitable IG policies
  accountability

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PIAG Conditions - 2

• All organisations/users to have Data Protection
  registration sign Statement of Compliance (SoC)
  (when issued)
• Non-NHS users - contracts with CfH security
  confidentiality policies
• SUS data handling system security policies to
  become part of Statement of Compliance
• VD regulations apply, so STD data into SUS to be
  anonymised
• SHAs can have full postcode, but no other patient
  identifiable data

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PIAG Conditions - 3

• Training for NHS management info staff on
  Confidentiality CRG
• Communicate with NHS re S60 approval conditions
• Clinical audit - local v national
• Separate patient identification role from data
  management/analysis role
• Disease register information only to be added
  with patient consent

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Primary Secondary Uses
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Pseudonymisation Pilot

• Pseudonymisation Pilot - understanding impact of
  pseudonymisation on
• systems,
• analysis reporting
• business processes- both process and outcomes
• Update via SUS website
• Future SUS releases - increased restrictions on
  clear data, need experience with pseudonymised
  data
• When pseudo extracts are available, download and
  load into local systems - feedback will be welcome

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Access Controls Pseudonymisation

• Secondary Uses Services

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Access Control - RBAC

• SUS holds patient identifiable data and needs
  access control
• CfH use Role Based Access Control (RBAC)
• Combination of Activity (or Business Function
  (BFs)) Organisation determines which data can
  be accessed
• RBAC works by collecting information about you,
  what you are registered to do and presenting this
  to SUS, which interprets this to allow access to
  relevant functionality and data

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Access Control - RBAC

• RBAC comprises
• Registration via organisations Registration
  Agent
• Smartcard with users identifier (UUID)
• the Spine Directory Services (SDS) holds User
  Role Profile (URP) containing organisation code
  and BFs
• User logs on to Spine Portal
• SDS passes URP info to the SUS presentation layer
• SUS has logic to apply the related application
  function to the data for the users organisation

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Access Control - RBAC
SDS
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Access Control - RBAC

• Users are individually and legally responsible
  for their Smart cards and system access through
  their cards
• RBAC and SUS can provide audits on access to SUS

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Access Control - SUS

• 2006 A B-1 Releases
• Activities re-defined, but use same codes
• Tactical solution strategic solution via RBAC V
  22 release
• Previous granting of SUS activities to user
  profiles being revoked - except current users of
  B1500, B1560 B1565
• All users will need granting of new profiles via
  local RA

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Access Controls - Activities
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Access Control - Organisations

• NHS Commissioners
• NHS Providers
• SHAs
• Shared Services
• Register with NHS Administrative Codes Service
  (NACS)
• Provide SUS with organisational information
  signed off by Caldicott Guardian
• Undertaken in name of host organisation
• (see SUS website CE Bulletin)

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Access Control - Shared Services
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Who can use SUS?

• Initially up to 3 people per organisation can
  have SUS activities in their user profile
• Shared Services negotiate with their
  organisations
• Small number of users is an IG Constraint - plus
• ensures fair initial access
• avoids overloading the system
• appropriate for extract service
• Numbers will increase as analysis reporting
  functionality in SUS increases
• Users should attend Part 1 2 training

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Pseudonymisation - 1

• SUS holds patients records with
• NHS Number (held in clear, ie unchanged)
• Root key encryption (never revealed)
• Group key encryption of the root key encryption
• Group key version used as NHS Pseudonym
• Consistent across different users in NHS
• Non-NHS extracts have pseudonyms generated by
  Oracle function as data extracted
• Non-NHS pseudonyms different from NHS pseudonym,
  consistent within organisation, different between
  organisations

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Pseudonymisation - 2

• SUS Data Handling Protocol part of Statement of
  Compliance forbids mixing clear and pseudo data
• If this happens, regarded as breach of IG rules
  and potentially disciplinary offence
• As use of patient identifiable data is reduced,
  the root key and/or group keys will be
  regenerated to make any earlier code breaches
  meaningless
• Future RBAC restrictions on individual users
  access to clear and pseudo data

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Pseudonymisation - 3
SUS
PDS
NHS pseudo view
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Shared Services
SDS
SUS
PCT re-configuration handled the same way
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SUS Data Handling Protocol

• SUS Data Handling Protocol
• In draft form
• Draft will be on SUS website before SUS goes live
• Covers
• Purpose status of the protocol
• SUS Data Data Extracts
• Data Storage
• Data Management Usage
• Data Release
• Audit

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SUS Practical Issues

• Secondary Uses Services

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SUS Practical Issues

• NWCS Termination
• Implementation Guidance
• Impact on business processes local systems
• Pseudonymisation

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NWCS Termination

• Contract terminates 31 December 2006
• Last data submission 15 December
• Re-submissions by 22 December
• Copy data being created and transferred to CfH
• McKesson obliged to destroy NWCS data
• Users need to plan cutover to SUS
• Trusts need XML dataflow to SUS to be operational
• Can use XML solution for User Defined Formats
  (UDF) to Mar 07

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Implementation Guidance
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Implementation Guidance

• On booking website or SUS website, covers
• CDS Submissions
• PCT Reconfiguration
• Extract Mart - Functionality summary use
• PbR Mart - differences use
• Impact on local systems
• Implementation issues

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Things to note

• Same IG rules apply to PbR Extract Mart
• Differences between PbR Extract Mart - content
  timing
• SUS schedules extracts, sends to My Documents,
  notifies arrival
• Templates and their use
• PCT Reconfiguration supported

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SUS CDS dataflow
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Data Quality

• Data Quality facilities
• Tracker
• DQR
• eDQRS
• Known IG problem on eDQRS error reports
• Improvements expected with XML flows
• Data Quality support via IC

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Data Quality

• Data integrity check work undertaken
• Close match between SUS NWCS, but
• NWCS generates duplicate records
• NWCS sends out there to clear data to
  commissioners, but not to database
• Some outstanding minor issues in SUS, no major
  flaws
• Majority of data problems can be resolved by
  working with providers

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Impact on local systems

• Plan cutover from NWCS to SUS
• Re-extract all 06/7 from SUS?
• Pull data - may need to change file handling
• Formats different from EDIFACT
• Bulk update only
• Local responsibility for system updates

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Differences Between NWCS and SUS in Use

• Summary
• Timing and management of interchanges
• Flex freeze dates
• SUS - may take longer time overall (initially) to
  process interchanges for Extract Mart, but SUS
• Populates warehouse
• Enables different extracts
• Enables consistency of data for commissioning
• Provides flexibility

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Going Live - 1

• SUS 06B-1 - go-live date 6th Nov
• UAT on live system - RBAC basic checks
• User access - late November / early December
• Transition -
• prior to go-live, SUS shut down from late Oct to
  early Nov
• precise dates to be agreed with DH to fit in with
  Q2 flex and freeze dates
• last submission, first extract dates to be
  published

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Going Live - 2

• CE Bulletin on SUS user registration Shared
  Services - 26 Sept
• New business functions - published by 2 Oct
• Shared Services -
• please register with NACS by 13 Oct
• please inform SUS Helpdesk/Vicki by 13 Oct
• Existing User Profiles (except current B1500,
  B1560 B1565 users) - revoked by 15 Oct
• New User Profiles (for all users) - registration
  starts from 30 Oct, aim to complete 8 Nov
• Please check SUS website for latest news

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Some Issues Raised

• Number of Users per organisation
• Supporting Specialist Commissioners
• Data deletion facilities
• Accessing training courses

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SUS Practical Issues - supporting facilities

• Secondary Uses Services

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Reference Data

• Reference data - key component of SUS - examples
• Basic data, such as post code address files
• Derivations, such as super-output areas
• Population data for denominators
• NACS codes

• Support service to be provided by NASP, but IC
  role in ensuring reference data is timely,
  consistent, etc

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Metadata -1
Metadata Data about the data

• Metadata should give
• Details of data sources and provenance
• Individual data item definitions and descriptions
• Classification descriptions and rules - simple
  and complex
• Definitions of and construction rules for
  composite indicators or measures
• Rules applied for the treatment of invalid or
  missing data within analysis and reports
• Descriptions of reports and analysis, including
  dimension construction and scales
• Interpretation guidance and decision support
  text, including alerts and warnings

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Metadata -2

• Facilities are available in SUS, but
• Will start small
• Will use hyperlinks to other sources when
  possible, eg to NHS Data Dictionary
• Be maintained by The Information Centre
• Support service will need to be developed to
  provide editorial facilities and ensure timely,
  consistent, etc

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Help Text Documentation

• SUS Report screens contain context specific help
  text.
• Help function displays an additional screen
  showing details about the report - part of the
  metadata
• Access to other Metadata will be available on a
  further screen
• More detailed guidance will be on the SUS web
  pages
• More documentation on SUS web pages
• Working with BT on common language for helpdesk
• NASP SUS Team may only know about any shortfall
  on metadata, documentation help text when users
  yell

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Getting help

• SUS exists to provide a service
• If SUS is not working, for help contact as below
• Via BT Helpdesk - bt.sus.helpdesk_at_bt.com
• Or 0845 600 2558 8.30am to 5.30pm Monday to Friday

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Part 2 Training - 1

• BT provided
• 06A - hands-on 06B-1 via e-Learning
• User Assurance of scripts, materials,
  presentation
• 1 day course in IT training rooms, full day - to
  obtain the maximum benefit it is advised to
  attend promptly and stay to the end
• Please complete evaluation form

• Booking direct via
• http//etdevents.connectingforhealth.nhs.uk
• Keyword NASP

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Part 2 Training - 2

• UAT happening in parallel - may lead to minor
  changes to live system compared with Training
  system
• Branding in training products will be Ardentia,
  but will change to NHS by time SUS goes live

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User Involvement

• User Involvement
• User Assurance
• NWCS/SUS TUAG - for transition to SUS -
  essentially data technical (Chair - Chris
  Hoare)
• PbR UG started (Chair - Mike Foster)
• National User Group - to be set up
• Ideas, metadata, sharing skills, etc

• To maintain, develop and improve SUS, we need to
  know about problems or ideas
• Please contact us via the SUS Helpdesk onissues
  or to raise questions

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Long Journey

• Infrastructure in place
• Starting small - eg no of users
• Trying to make sure things work - minimise
  teething troubles
• Will add facilities and functionality - eg
  benchmarking
• Incremental developments
• Will notify of major releases
• Need user involvement
• Check SUS website for news

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Questions (and possibly answers)