The Future of Public Health Information and Intelligence Hampshire Health Record

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The Future of Public Health Information and
Intelligence Hampshire Health Record
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Hampshire Health Record

• Shared primary and secondary care record
• Based on extracts from GP systems and Trust
  systems.
• Browsable clinical record
• Database for analysis

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GP Record (Read codes) (c900,000)
OT/CN/ PT/Pod
SAP
IP/OP/AE CMDS (Other data sets?)
Hospital records (SUHT PHT) Pathology Radiology
Correspondence (c 14.4 million documents)
Analytical Clinical Data Repository (ACDR)
Hampshire Health Record (HHR)
CDR Patient Index
Personal Demographic Service
Clinical view
Care Pathway Reports Prevalence GP and
hospital activity Clinical outcome
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Number of Records

• GP Records
• 102 / 210 Practices participating117 million
  entries for c 900,000 patients
• 74 Southampton PCT
• 50 Hampshire PCT
• 30 Portsmouth PCT
• Hospital Records
• 14.4 million documents on 640,000 patients
• Feeds live from SUHT, PHT
• ( WEHT and NHHT live within 3/12)

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Data extracted to Analysis Server(linked by
encrypted NHS Number and GP practice codes
anonymised)
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Information to support Practice Based
commissioning projectDiabetes pathway analyses

• Development of analytical database
• Initial queries on Diabetes Pathway
• Able to select PCT, PBC group, Practice or GP
• Additional tables on secondary care use
• Selection of specialty, PBC group

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Diabetes pathway reports

• Process of initiation of care
• Process of monitoring in established diabetics
• Events in transition from juvenile to adult
  services
• Incidence of complications
• Use of hospital services ( IP/OP/ AE)
• Cost of hospital care

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Whole pathway analysis

• What proportion of practice diabetic population
  meets the minimum standards of
• Initiation of care
• Monitoring of risk factors
• Compliance with diet/ weight/ self monitoring
• Incidence of complications at 5, 10, 15 years
• Emergency / elective use of secondary care

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Summary by Practice

• Practice 50 has a relatively good performance in
  the initiation of diabetes care and monitoring of
  patients with diabetes is average. The incidence
  of complications and the costs and volumes of
  secondary care are low.
• Practice 150 had a poor performance at initiation
  of care, and also for monitoring. The
  complication rate is high and the costs of
  inpatient care are high, with high use of bed
  days, outpatient and AE attendances.

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Health Warnings

• Data need to be reviewed by the individual
  practices to check the accuracy of the results.
• Consistency of GP record keeping needs to
  improve.
• Some records excluded ( lt1 at present)
• Some data extraction problems to be resolved
• Need to adjust for mix of
• Age,
• Ethnic group
• Social deprivation
• Duration of diabetes

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Use by PBC Group

• Opportunities for improving primary care to
  reduce secondary care costs
• Benchmarks for practices within group and with
  other groups.
• Evaluate total costs and effectiveness of
  enhanced services / remodelled service delivery.

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Other care pathways?

• Stroke/ Cerebro-vascular disease
• Chronic Obstructive Airways Disease
• Coronary Artery Disease
• Cancers?

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Other potential applications

• Clinical Audit.
• Post discharge surgical wound infection rates
• Quality of anticoagulant control
• Outcomes of out of hours service/ AE department
  care.
• Duplication of tests / imaging between primary
  and secondary care
• Quality of follow up of abnormal test results/
  clinical measures.

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Other potential applications

• Patient management
• Identify high risk patients
• Identify low compliance patients
• Flag patient in trials
• Clinical research
• Follow up of trials patients
• Cohort studies of specific treatments/
  interventions, exposures, occupations etc