NHS Data Model and Dictionary Service Open Day

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Welcome

• NHS Data Model and Dictionary Service Open Day

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Aim of the Day

• To enable users to discuss the
• NHS Data Model and Dictionary
• with the National team

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Topics for Discussion

• Introductions
• Overview of the "Introduction to the NHS Data
  Model and Dictionary" Training Course
• Role of the NHS Data Model and Dictionary Service
   
• Change Process
• NHS Data Model and Dictionary Service Website  
• NHS Data Model and Dictionary Service
  Consultation Website
• Navigation of the NHS Data Model and Dictionary  
• Lunch around 1230
• Using a Patient Pathway for Outcome Analysis
• Measuring 18 weeks  
• Commissioning Data Set Version 6
• Open Discussion
• Review of the day
• Close no later than 330pm

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Introduction to the NHS Data Model and Dictionary
Training Course

• Objective
• Develop a greater understanding of the NHS Data
  Model and Dictionary
• Target Audience
• NHS Information professionals in Trusts, PCTs
  and Health Authorities
• Delivery
• 2 day course based in Leeds, 6 times a year
• Next course October 2007 in Leeds

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Course ContentThe training course includes
presentations on the following topics

• Background
• Data Standards
• The Change Process
• NHS Data Dictionary
• Data Validation
• Data Modelling
• Data Definition Queries

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Course ContentOn successful completion of the
course, participants will be able to

• Understand the need for Data Standards
• Understand how to navigate the NHS Data
  Dictionary
• Read a Data Model
• Use the NHS Data Dictionary to resolve data
  definition queries

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Any Questions
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NHS Data Model and Dictionary Service Products

NHS Data Model and Dictionary Website
NHS Data Model and Dictionary
Frequently Asked Questions
NHS Data Model and Dictionary Consultation Website
Supporting Development
Training Courses
Open Days
Query Resolution
Mailing List
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Role of the NHS Data Modeland Dictionary
ServiceCustodians of the NHS Data Model
Dictionary

• Help users read and understand it
• Helpdesk
• Open Days
• Training course
• Publish it
• Identify changes to it
• Help policy leads change it

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NHS Data Model and Dictionary

• Well established
• English
• National
• Standard
• Enabling Policy
• To be implemented
• Throughout the NHS

• Policy examples
• Purchaser / Provider
• Casemix
• Commissioning
• Waiting lists
• New ways of working
• Treatment functions
• National Service Frameworks

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History of the dictionary

• Established 1985 - Körner
• Minimum Data Sets - all the data required to
  manage a district
• Contract Minimum Data Sets - a sub set of the
  data items required to contract
• Renamed Commissioning Data Sets

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NHS Data Model and Dictionary Service

• Commissioning Data Set and Mental Health Minimum
  Data Set Message Schema
• More of these, later

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Does the NHS work?
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Does the NHS work?

• Enables DH and NHS to
• Monitor
• Compare
• Model
• Predict
• Manage
• Pay

• Main stakeholders
• Department of Health
• Information Centre
• Monitor
• Healthcare commission
• Wider NHS
• General Public
• Suppliers

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Any Questions
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Change Process

• Driven by policy
• Often involves multiple Data Set Change Notices
  (DSCNs)
• Notification
• Review of Central Returns (ROCR) mandate
• Dictionary update
• Commissioning Data Set Changes (CDS)
• Message schema changes

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Who Mandates Change?

• Review of Central Returns (ROCR)
• Mandate collection
• Mandate NHS
• Concentrate on burden
• Restricted influence over Foundation Trusts

• NHS Information Standards Board (ISB)
• Assure the standard and assess the impact of
  changes
• Publish DSCNs
• Linked to supplier contracts

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What is the NHS Data Model and Dictionary Service
(DMDS)?
Government Policy ROCR Request Helpdesk etc..
Update
Issue
Approved
Stakeholders
Rejected
ISB
Analysis
Resubmit / Conditional approval
Consultation
Early liaison with ISB
Draft
Further Analysis
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Change Process

• Operational standards are approved by NHS
  Information Standards Board
• Standards must have the following defined before
  they are approved
• Scope and purpose
• Department of Health policy sponsor
• Customer need
• Implementation plan including testing and
  training
• Business justification
• Risks
• Research into existing similar standards
• Interdependencies and interoperability

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Change Process

• Other types of standard exist
• Fundamental - building blocks
• e.g. SNOMED, XML
• Framework strategic
• e.g. e-GIF
• Changes to existing standards are
• communicated through Data Set Change Notices

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Any Questions
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NHS Data Model and Dictionary Service Website

• http//www.connectingforhealth.nhs.uk/systemsands
  ervices/data/datamodeldictionary/index_html
• It holds
• News
• NHS Data Model and Dictionary
• Help (Frequently Asked Questions) (Updated)
• Events (New)
• Mailing List
• Consultation Website
• Publications (New)
• XML Schemas
• CDS Supporting Information (New)
• Link to Data Set Change Notice Website
• Useful Links (Updated)

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Options for ResolvingData Definition Queries

• Check the NHS Data Model and Dictionary
• Look at Frequently Asked Questions
• Search other websites (e.g. ISB etc)
• Contact other Help Desks (e.g. SUS etc)

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Data Definition Queries

• Data Standards and Products Helpdesk
• datastandards_at_nhs.net
• full name
• job title
• telephone number
• full postal address
• organisation code (if you are an NHS user)
• suggested resolution

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Any Questions
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Consultation Website What is it?

• View NHS data standards during development stages
• Review and comment on work in progress
• Discuss work with the NHS Data Model and
  Dictionary Service

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Consultation Website Example Sites

• 18 weeks
• Quarterly Monitoring Accident and Emergency
  Services (QMAE)
• Commissioning Data Set V6
• Mental Health Minimum Data Set
• Removal of EDIFACT
• Genitourinary Medicine Access Monthly Monitoring
  Data

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Consultation Website Access

• Email
• datastandards_at_nhs.net
• Note Users granted access to the Consultation
  Website are automatically added to the NHS Data
  Model and Dictionary Service Mailing List

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Any Questions
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Data Model Components
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http//www.datadictionary.nhs.uk
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Data Dictionary Navigation Options

• Data Collections
• Commissioning Data Sets
• Supporting Data Sets
• Clinical Data Sets
• Central Returns
• Diagrams
• Definitions
• Search
• All Items Index

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NHS Data Dictionary Release Cycle

• The NHS Data Model and Dictionary is updated once
  changes pass their implementation date
• Often this includes April and October
• May include other months, for example August
  2007
• Each item is independently version controlled
• The history of every change is included with
  every item

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Any Questions
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Intelligent use of information
Using a Patient Pathway for Outcome Analysis

• to hit Nicholas Oughtibridge,
• the aim as well as the target

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Intelligent use of information

• to hit Nicholas Oughtibridge,
• the aim as well as the target

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Traditional Measurement

• First consultant out-patient appointment
• 13 weeks
• Waiting for elective admission
• Six months
• Arrival to discharge at AE
• Four hours
• Practice and GP Access
• 24 / 48 hours

• G U Medicine
• 48 hours

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Complex definitions

• Suspensions
• Deferrals
• Reasonable offers
• Patient cancellations
• Hospital cancellations
• DNA
• CNA

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What has this told us?
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Most queues have been hidden!

• Out-patient following
• emergency admission
• AE attendance
• Endoscopies
• Except direct access GP referral
• Admitted
• Ready for discharge

• Audiology
• Mental health
• Clinical Assessment
• GPwSI
• Follow up clinics
• Non-consultant clinics
• Imaging
• Non-GP referral

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Key features

• Regular flow
• Predictable peaks in demand
• Each stage is connected to the previous and the
  next

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Traditional measurement

• Concentrates on start and end
• Misses out many stages in the middle
• Counts activity and people queuing for activity

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Traditional measurement

• Measure Stations
• Counts activity and queuing for activity
• Ignores
• the destination
• the journey
• time

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Hide the passengers
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For how long
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Minimise hidden waits

• Measure from referral to the start of treatment
  designed to resolve the patients problem or
  condition
• Take the opportunity to
• understand patient journeys
• look beyond the target (First Definitive
  Treatment)

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Problems

• An incident in one place can have an impact on
  the whole service
• The flow has to find alternative routes
• Difficult to manage
• Difficult for customers

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Problems

• An incident in one department can have an impact
  on the whole service
• The flow has to find alternative routes
• Difficult to manage
• Difficult for patients

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Mornington Crescent

• The Mornington Crescent tube station is on
  London's Northern Line between Euston and Camden
  Town on the Charing Cross Branch.
• However, if you travel between the same two
  stations on the City Branch, the station simply
  isn't there. Now you see it, now you don't.

• The game is intended as a parody of complicated
  strategy games, and particularly satirises the
  complex rules and terminology that evolve around
  games such as contract bridge or chess.
• Wikipedia

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Mornington Crescent

• But is it all just a game
• Im sorry. I havent a clue!

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No departments are isolated
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Some journeys

• GP Written referral
• Home
• GP
• Consultant first
• Diagnostics
• Consultant follow up
• Treatment
• Follow up
• Discharge
• Home

• GPwSI or CAS
• Home
• GP
• GPwSI or CAS
• Diagnostics
• Consultant first
• Treatment
• Follow up
• Discharge
• Home

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Isolation barrier to success

• No department is isolated
• Patients are referred
• In
• Out
• Inter-departmental referrals make the patient
  journey
• Departments may be in different providers

• Analyse the flow
• Identify the blockages
• Measure the variation
• Spot surplus capacity
• Link outcome to the journey

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Understand the flow

• Link the whole patient journey
• Concentrate on the patient experience
• Understand patient choices
• Use scheduled activity identify scheduled
  problems
• Dont plan to fail

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Core techniques to managewaiting lists

• Validation
• Primary Targeting lists
• Eliminate unnecessary queues
• Eliminate unnecessary steps / activities
• Schedule likely events in advance
• Measure capacity in appropriate units

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Validation

• Ensure the people you think require treatment are
  willing and available to have treatment
• 18 month target was achieved using validation
• Available includes
• patient choice of treatment
• clinical availability / suitability

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Primary Targeting Lists

• A list of the patients needing treatment in order
• Historically effective for stage of treatment
• Major contributor to 12 month and 17 weeks
  targets
• Still relevant
• Now need to look at the whole pathway

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Eliminate unnecessary queues

• Reducing queues reduces the variability in
  treatment time
• Queues should be for different streams /
  processes
• Queues should not be for arbitrary administrative
  reasons
• Eliminate back doors to treatment which allow
  queue jumping by those in the know

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Plan ahead
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Plan ahead

• Book known or anticipated stages in advance
• Schedule activities on the same day where
  possible
• Allow patients to choose mutually convenient
  slots where possible
• Schedule resources as well as people

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Measure in appropriate units

• Clinic time required
• Clinic slots required
• Bed days anticipated
• Theatre hours used
• Scanner time required
• Equipment required
• Use the same units for activity, backlog,
  capacity demand

• Number of first consultant led appointments
• GP Written referrals received
• Finished Consultant Episodes
• Patients waiting
• Patients seen last month

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Key statistics

• 2.671 million journeys per day
• 3.009 million passengers use the 2 platforms at
  Mornington Crescent per year
• 77.564 million passengers use the 8 platforms at
  Kings Cross per year

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Outcome analysis
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Outcome analysis

• By looking at the patient pathway early
  interventions can be assessed in terms of outcome
• Adherence to care pathways can be assessed

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Any Questions ?
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Measuring 18 weeks

• Changes for a sustainable approach

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Aim

• To define and measure the length of wait from GP
  referral to first definitive treatment

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What are we trying to measure?

• Lets look at some pathways

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The strategic approach

• Measurement using the CDS
• Patient Pathway Identifier to link records
• Referral to Treatment Period Status to identify
  the anticipated or final status of each activity
• Referral to Treatment Period Start Date and
  Referral to Treatment Period End Date

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A worked example - Referral
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A worked example - Appointment
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A worked example - Attended
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A worked example - X-Ray booked
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A worked example - X-Ray attended
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A worked example - Decide to admit
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A worked example - TCI given
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A worked example - Admitted
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Timetable - content
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Timetable - submission
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Any Questions
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Commissioning Data Set Version 6
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Commissioning Data Set Purpose

• Allows organisations to receive activity level
  data
• Supports Commissioning
• Feeds Hospital Episode Statistics
• Covers
• Past, current and future admitted patients
  including day case, long stay and psychiatric
• Past and future out-patients including
  ward-attenders, nurse/midwife/therapist and
  diagnostics
• Past Accident and Emergency attendances

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Commissioning Data Set Version 6

• Evolution over 15 years, not revolution
• Move to re-use common components
• Summary of time-table
• Notice of change published in May '06
• Schema and Tables published May 07
• Expected to be mandatory April 08

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Commissioning Data Set 6

• XML protects the integrity of the data
• Commissioning Data Set 5 has proved challenging
  to some providers
• Prevents invalid data for almost all fields
• Exceptions include NACS, ICD, OPCS, READ

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Categorisation of Data Quality
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Categorisation of Data Quality
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If the admission is in a series of regular day or
night admissions Then use either National Code 0
or 1 Otherwise, dont send the field
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A number
One digit long
Values 0 or 1
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Main New Content

• PbR
• Paediatric and neonatal critical care
• Discharge ready date
• Age

• 18 Weeks
• Pathway identifier
• RTTP data items
• Future out-patients
• Earliest reasonable offer date

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Big impact - Content

• Future out-patients
• Elective Admission List
• Critical Care
• Patient Pathways
• Referral to treatment periods
• Diagnostic systems

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Big impact - Submission

• Frequency moving to within 4 days of a change
• Net change protocol for all routine submissions

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Any Questions
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Open Discussion
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Review of the day

• Please complete the Evaluation Form