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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The NHS Data Model and Dictionary for England

• A collection of definitions about data
• Datum a single piece of information, as a
  fact, statistic or code
• Dictionary a selection of the words of a
  language, usually arranged alphabetically,
  giving information about their meanings

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The NHS Data Model and Dictionary for England

• Model A simplified view of reality
• allows some ideas to be shared

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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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Domestics

• Timings
• Toilets
• Fire Drill (not planned for today)
• Mobile Phones
• Smoking - Cavendish Square
• Breaks served in the lounge
• Lunch served in the lounge

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Agenda
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Some Ground Rules

• This will be short, and very boring if we talk
  and you listen - challenge us!
• We will discuss current work - this is our
  direction of travel, not definitive standards
• Your comments will not be attributed to you

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Introductions by table

• Your
• Name
• Role
• Organisation

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Questions

• Feel free to ask questions at any time
• If there is an area you want to explore in the
  open discussion, make a note for later

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Slides/ Evaluation

• The Open Day Slides will be available on the NHS
  Data Model and Dictionary Service website at
• http//www.connectingforhealth.nhs.uk/systemsands
  ervices/data/datamodeldictionary/index_html
• An Evaluation Questionnaire will be sent to you
  by Events Online - please complete it

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NHS Data Model Dictionary ServiceThe Team

• Summary of Role and Responsibilities
• Analyse, model and develop change proposals for
  NHS Data Standards
• Provide support and guidance on NHS Data
  Standards and the NHS Data Model and Dictionary

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NHS Data Model Dictionary ServiceThe Team

• Content Manager Nicholas Oughtibridge
• Business Analysts
• Angela Faulding
• Bushra Khatoon
• Cath Chilcott
• David Barnet
• Gill Foley

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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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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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NHS Data Model and Dictionary

• The NHS Data Model and Dictionary
• provides a reference point for assured
  information standards to support health care
  activities within the NHS in England
• together with Data Set Change Notices represent
  the agreed data standards which should be
  collected across the NHS.

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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 February
  2008
• Each item is independently version controlled
• The history of every change is included with
  every item

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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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NHS Data Model andDictionary Service Website

• It holds
• News
• NHS Data Model and Dictionary
• Help (Frequently Asked Questions)
• Events
• Mailing List
• Consultation Website
• Publications
• XML Schemas
• Commissioning Data Set Supporting Information
• Link to Data Set Change Notice Website
• Useful Links

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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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Frequently Asked Questions
Categories
A-Z Listing
Popularity
Sub Categories
FAQ Pages
FAQ Pages
FAQ Pages
FAQ Pages
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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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Options for ResolvingData Definition Queries

• Check the NHS Data Model and Dictionary
• Look at Frequently Asked Questions
• Search other websites
• e.g. Department of Health, Information Standards
  Board for Health and Social Care etc
• Contact other Help Desks
• e.g. Secondary Uses Service, National
  Administrative Codes Service 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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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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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
• Commissioning Data Set V6
• Mental Health Minimum Data Set
• Removal of EDIFACT
• Genitourinary Medicine Access Monthly Monitoring
  Data
• Identifying the Responsible Commissioner
• 18 Weeks Clock Rules Suite

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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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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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NHS Data Model and Dictionary Mailing List What
is it?

• It is designed to make users aware of NHS Data
  Model and Dictionary Service products, such as
• New NHS Data Model and Dictionary releases
• Forthcoming events such as NHS Data Model and
  Dictionary Open Days, Training Courses
• Consultation of a draft Change Request

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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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Introduction to the NHS Data Modeland Dictionary
Training Course

• Objective
• Develop a greater understanding of the NHS Data
  Model and Dictionary
• Target Audience
• NHS Information professionals in Trusts, Primary
  Care Trusts and Health Authorities
• Delivery
• 2 day course based in Leeds, 6 times a year
• Next course June 2008 in Leeds

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Course ContentThe training course includes
presentations on the following topics

• Background
• Data Standards
• Change Process
• NHS Data Model and 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 Model and
  Dictionary
• Read a Data Model
• Use the NHS Data Model and Dictionary to resolve
  data definition queries

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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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Supporting Development

• Each Change Request
• Requires a
• Sponsor and
• Developer
• Is assured by the Information Standards Board for
  Health and Social Care

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Supporting Development

• The Information Standards Board for Health and
  Social Care
• provide an independent mechanism for the
  assurance and sign off of Information Standards
  for use in the NHS (England)
• publish the assured change as a Data Set Change
  Notices (DSCN)
• DSCN Mailing List http//www.connectingforhealt
  h.nhs.uk
• /dscn/mailist

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Any Questions
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ASSIST National Conference Awards

• Thursday, 22 May 2008
• London Oval Cricket Ground
• Key note speaker Matthew Swindells

Book online _at_ http//www.connectingforhealth.nhs.u
k/events/
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www.dh.gov.uk
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National Workforce Data

• The Operating Framework for 2008/09
• Electronic Staff Record (ESR) Data Warehouse
• Strategic workforce planning and monitoring
  purposes

Human Resource and Payroll System for England and
Wales
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The Operating Framework for 2008/09
National Workforce Data

• Roles Responsibilities
• Strategic Health Authorities
• NHS Trusts
• Primary Care Trusts
• Expected to profile and monitor their workforce
  numbers and payroll monthly

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National Workforce Data
Introduces data definitions for Workforce
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National Workforce Data

• Categories
• Organisational
• Personal/Operational
• Deployment
• Education
• Absence
• Staff Movements and Numbers

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National Workforce Data

• Key Points-
• Not linked to Main Specialty Code
• Evolution of Workforce data needs means further
  releases expected

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Cancer Waiting Times

• Cancer Reform Strategy (2007)
• Align with 18 weeks data set, cancer registry and
  radiotherapy collections
• Incorporate more cancer patients under the 62 day
  referral to treatment pathway
• Continued

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Cancer Waiting Times

• Cancer Reform Strategy (2007)
• Include all cancer patients requiring more than
  one treatment for a primary or recurrent cancer
  receive all their treatment within 31 days of
  being ready to start treatment
• Patients with breast symptoms where cancer is not
  suspected

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Cancer Waiting Times

• Support
• Patient Outcomes \ Treatment Packages
• Service reconfiguration and local planning
• Policy development and decision-making.
• Cancer registries and their datasets

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Cancer Waiting Times

• Key points
• Extended data set imminent
• Reporting through Secondary Uses service from
  2012

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New definitions

• Consultant led activity / service
• Non-consultant led activity / service
• Interface Service

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Sex and Gender

• Sex
• A statement, as far as is known, about the
  phenotypical sex of the person based on
  observation of his/her biological and
  physiological characteristics
• Not known
• Male
• Female
• Indeterminate

• Gender
• A statement by the individual about the gender
  they identify themselves to be (i.e.
  self-defined)
• Not known
• Male
• Female
• Other - The person has a clear idea of what their
  gender is, but it is neither discretely male nor
  female, e.g. agendered, bi-gendered,
  pan-gendered, transgender, third gender

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Sex and Gender

• Sex
• How the body looks

• Gender
• How you choose to behave

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Person Sex at Registration and Gender Recognition
Act 2004

• The ONS data element Person Sex at Registration
  is the persons legal sex
• as originally defined at birth registration
• and possibly modified by issue of a Full Gender
  Recognition Certificate under the Gender
  Recognition Act 2004.
• The ONS may be the source of information for NHS
  data about Person Sex.
• People who are planning to have their Sex at
  Registration entry modified must be made aware
  of the implications of not disclosing their
  phenotypical sex to a health care professional
  when seeking health care.

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Ethnic Category

• Mandating collection in non-admitted settings
  including clinics and Accident Emergency
• Updating Commissioning Data Set 10, 20 and 21
• Updating Schema for 6-1

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Commissioning Data Set 5 closedown

• Commissioning Data Set 5 is no longer the
  approved standard
• SUS supports the current standard and the
  immediate past standard
• Release 4 (October 2008) requires a new schema
  6-1
• Release 4 cannot support Commissioning Data Set 5

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SUS Output

• Defining SUS derived output for
• 18 weeks
• Mental Health
• Will be used for Performance Sharing for 18 weeks

Breakout
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Any Questions
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Break Out Sessions

• Developing Standards
• Navigation and the Consultation Website
• Healthcare Resource Group (HRG) 4
• Secondary Uses Service and 18 Week Reports

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Healthcare Resource Group 4 (HRG4)

• 33 Expert Working Groups
• Managed by the Information Centre for Health
  Social Care
• Developed the HRG4 currency
• Support Payment by Results tariff policy

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Healthcare Resource Group 4 (HRG4)

• A major revision of groupings increased from 550
  to 1,400
• Focus on cost rather than length of stay
• 25 Increase in OPCS codes

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Healthcare Resource Group 4 (HRG4)

• History
• 2006/7 Reference Costs used HRG4 for the first
  time
• Used to inform the 2009/10 national tariff under
  Payment by Results

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Healthcare Resource Group 4 (HRG4)

• Expected
• 2007/8 Reference Costs use HRG4
• Use to inform the 2010/11 national tariff

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Healthcare Resource Group 4 (HRG4)

• Increased clinical coverage
• Specialist Palliative Care
• Diagnostic Imaging
• Chemotherapy
• Radiotherapy
• Critical Care
• Rehabilitation

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Healthcare Resource Group 4 (HRG4)

• Improved use of Complications Co-morbidities
• to reflect variations in severity and complexity

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Healthcare Resource Group 4 (HRG4)

• Unbundling activity
• to handle high cost drugs and other high cost
  elements of care

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Healthcare Resource Group 4 (HRG4)

• Setting independence
• unbundling will help to make
• HRGs setting independence

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HRG4 Raise Awareness

• Involve clinicians-
• To ensure accurate coding and optimise HRG
  classification
• To assist in identifying new data items
• To help develop meaningful reference costs
• To own and use the data
• To help you to interpret variations from the norm

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Healthcare Resource Group 4 (HRG4)

• Key Issues for Reference Costs
• Data Quality
• Accuracy
• Timeliness
• Director of Finance sign-off

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The Operating Framework for 2008/09 Standard
Contract Clause 29

• From April 2008
• Initially coded datasets weekly
• Comprehensively coded datasets monthly
• From April 2009
• Secondary Uses Service (SUS) standard repository
  for reconciliation and payments

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The Operating Framework for 2008/09 Standard
Contract Clause 29

• Failure to comply with the information
  requirements in terms of
• Accuracy
• Completeness
• Timeliness
• Can result in Main Body, Clause 29 being enacted
  which can result in funds being withheld

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So what they always say that!

• Host commissioners can instruct all
  commissioners to
• Withhold 10 of income until hosts receive /
  accept data
• No interest payments on withheld income

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HRG4 - Your involvement is vital!

• Remember-
• Raise awareness of HRG4 within your organisation
• Use OPCS-4.4 or lose money
• Involve clinicians
• SUS will be repository for payment,
  reconciliation and performance from April 2009

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Data Model Components
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Any Questions
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Genitourinary Medicine (GUM) Data

• Facts
• GUM is in the 18 weeks Target
• Consultant\Nurse\Midwife-led data must be
  submitted in the Out-patient Commissioning Data
  Set

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Genitourinary Medicine (GUM) Data

• Security Issues and Patient Confidentiality
• Sensitive data, such as HIV and venereal
• diseases must omit the following-
• NHS Number
• Birth Date
• Patient Name
• Postcode of Usual Address

• To be removed from CDS

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Genitourinary Medicine (GUM) Data

• British Association for Sexual Health and HIV
• Developing a list of venereal disease
  classification codes
• Exceptions to the sensitive data rule

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GUM Clinic Activity Data Set
Replaces the KC60 Sexually Transmitted Infections
Central Return with a patient level data set
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GUM Clinic Activity Data SetDSCN 04/2008 -
Sensitive Data

• Local Patient Identifier
• Lower Layer Super Output Area of Residence
• Age
• Gender

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GUM Clinic Activity Data SetDSCN 04/2008
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Genitourinary Waiting Times
Introduces a new aggregate level data set
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Genitourinary Medicine

• Remember-
• Consultant\Nurse-led activity must be transmitted
  in OP CDS
• Exceptions to the sensitive data rules
• Patient Name Address to be removed from CDS
• Included in 18 weeks

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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
• Mandatory by 31 March 2008

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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

• Payment by Results
• 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

• Move to WEEKLY within 5 days of a week end
• (7 day period)
• Net change protocol for weekly submissions
• Source Operating Framework

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Timetable content
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Timetable submission
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When does CDS 5 retire

• Formerly 31 March 2008
• Technically SUS only supports 2 versions,
  current and previous. CDS 5 retires as soon as
  we need any update to CDS 6.
• Expected withdrawal no later than Oct 2008

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CDS Version 6.1

• Release October 2008
• Content Changes Ethnic Category in-
• Outpatient CDS
• Future Outpatient CDS
• Coincide with withdrawal CDS Version 5

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Any Questions
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Measuring 18 weeks

• 'By 2008 no one will wait longer than 18 weeks
  from GP referral to hospital treatment.'
• The NHS Improvement Plan
• June 2004

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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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Whats new

• Multiple stages
• CAS / CATS / ICATS / RMC / Interface Services
• Outpatients, GU Medicine
• Admitted Patients
• Multiple providers Performance sharing
• Commissioner target

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The strategic approach

• Measurement using the Commissioning Data Set
• 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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Commissioning Data Set Version 6 Type IDs

• Accident and Emergency
• 010 Accident Emergency
• Care Activity
• 020 Outpatient
• 021 Future Outpatient
• Admitted Patient Care
• 120 Finished Birth Episode130 Finished
  General Episode
• etc

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Referral to Treatment (RTT) Status

• First activity
• Subsequent Activity
• Last Activity (First Definitive Treatment)
• Activity that is not part of a Referral to
  Treatment period
• Not yet known

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First Definitive Treatment

• the start of the first treatment that is
• intended to manage a patient's
• disease, condition or injury in a
• REFERRAL TO TREATMENT PERIOD

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A worked example - Referral
Future Outpatient CDS
First ACTIVITY in RTT Period
Referral Request Received Date
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A worked example - Appointment
Future Appointment Date
Future Outpatient CDS
First ACTIVITY in RTT Period
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A worked example - Attended
Outpatient CDS
Attendance Date
First ACTIVITY in RTT Period
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A worked example - X-Ray booked
Future Outpatient CDS
subsequent activity in RTT Period- further
ACTIVITIES anticipated
Future X-Ray Date
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A worked example - X-Ray attended
Outpatient CDS
X-Ray Attendance Date
subsequent activity in RTT Period - further
ACTIVITIES anticipated
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A worked example - Decide to admit
Elective Admission List CDS
Anticipated start of the FIRST DEFINITIVE
TREATMENT in the RTT Period
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A worked example - TCI given
Elective Admission List CDS
To Come In (TCI) Date
the start of the FIRST DEFINITIVE TREATMENT in
the RTT Period
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A worked example - Admitted
Start of the FIRST DEFINITIVE TREATMENT in the
RTT Period
Admission Date
APC Finished General Episode CDS
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Length of wait measurement

• For waits for non-admitted treatment
• (RTTP End Date RTTP Start Date)
• For waits ending in treatment through elective
  admission
• (RTTP End Date RTTP Start Date) less
• (RTTP End Date EROD for admission)
• This is the only adjustment to take into account
  patient choice

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Performance Sharing

• Shares success between the organisations
  involved in each patients care
• Used by Healthcare Commission from Jan 09
• Taken from Secondary Uses Service
• Requires CDS 6 or above with 18 weeks data

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Inter-provider transfer

• In an estimated 10 to 20 of referral to
  treatment periods involve multiple providers
• Receiving provider needs Patient Pathway
  information at the time of transfer
• Will also reduce administrative errors
• Many providers are using it internally too

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Any Questions
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Open Discussion
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Review of the day

• Please complete the Evaluation Questions which
  will be sent to you by Events Online
• Thank you for attending