Dr Bob Milne

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Scott Heald Dr Bob MilneMBChB, FRCGP

• Sharing Quality Information for Primary Care -
  Safely

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Scott Heald

• Head of Group, Healthcare Information Group, ISD
  Scotland
• Statistician by trade
• Member, SCIMP Executive

Bob Milne

• General Practitioner, Cults, Aberdeen
• Medical Director, PCCIU (Primary Care Clinical
  Informatics Unit)
• Member, SCIMP Executive and Working Group

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Bob Scott what a double act!
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About ISD

• Part of NHS National Services Scotland (NSS).
  Divisions include
• Information Services Division (ISD)
• Practitioner Services Division (PSD)
• Scottish National Blood Transfusion Service
  (SNBTS)
• ISD Core Services
• National collection and management of health
  care information
• Data definitions and standards
• Information Governance
• Provision of information technology services
• Interpretation and statistical advice

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Collecting Data 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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ISD and Information Governance

• ISD established Information Governance Programme
  in 2005
• Ensures information is
• Held securely and confidentially
• Obtained fairly and lawfully
• Recorded accurately and reliable
• Used effectively and ethically
• Shared appropriately and legally
• Helps patients to
• Be more confident about how the NHS handles their
  information
• Be sure that information about them will only be
  shared with those who need to know

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Data on General Practice

• Work Streams
• Practice Team Information (PTI)
• Practice Characteristics/Workforce
• Quality and Outcomes Framework (QOF) ( cf. PTI)
• Prescribing (e.g. PRISMS)
• Activities
• Data collection and secure storage
• Regular National Statistics publications
• Information request service
• Parliamentary Questions
• Reporting back to practices
• Research Projects / SAF maintenance and review

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Practice Team Information(previously CMR)

• Sample of 46 practices, covering approx 5 of
  Scottish population in 2005/06
• Broadly representative of Scotland by age, sex
  deprivation
• Allows Scotland-level reporting, but not NHS
  Board level
• Contacts with GPs since 1998/99
• Extended to the practice team (GPs plus
  practice and community nurses) in 2003/04.
• Team within ISD carry out QA on data

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Uses of PTI

• Regular feedback to PTI practices on their
  workload/activities
• Regular National Statistics publications on ISD
  Online
• Responses to approximately 350 information
  requests each year (incl Parliamentary Questions)
• Research
• post natal depression (PTI linked to SMR02)
  published in Clinical Outcome Indicators report
• Review of Scottish Allocation Formula

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PTI some key facts

• Approximately 28 million contacts per year
  (across whole practice team)
• Over 80 of practice patients consult with a
  member of the practice team at least once a year
• Conditions most commonly seen
• GPs - include skin problems, anxiety and
  depression
• Nurses skin problems, hypertension and diabetes
• Co-morbidity analysis, e.g. 28 of people
  consulting for diabetes also consulted for
  depression

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Using PTI an easy example

• Question How many patients consulted for
  diabetes in Scotland during the first year of the
  new GMS contract (2004/05)?
• Answer Estimated number of patients 173,150

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PTI sensible, but unanswerable questions

• Question How many adults in each NHS Board
  area were obese/severely obese in each of the
  past 5 years?
• Answer Health status questions are difficult to
  tackle using PTI. Obesity is only recorded if
  patient consulted for that issue in a year. Also
  tricky as PTI not representative at Board level
• Solutions
• expand PTI data extracts to include information
  on patient health status
• expand PTI sample to allow reporting at NHS Board
  level
• alternative data sources e.g. data held within
  PCCIU?

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PTI answering difficult questions

• PTI has been linked to other data to examine more
  complex questions, e.g. examination of postnatal
  depression anxiety (linkage to SMR02 published
  in NHS QISs 2004 Health Indicators Report)
• Obesity PTI data can nonetheless help in
  building up a picture of issues at national
  level.

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This sectionPrimary 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)?

• Programmes
• Electronic Questionnaire (EQ)
• 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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What has PCCIU done so far (3)?

• Common principles
• Appropriately targeted feedback and other reports
  can aid participating practices to develop better
  understanding about their patients, their
  illnesses and their management.
• By reporting on disease-based populations in a
  standard fashion directly to practices and more
  generally, we have contributed to the increased
  awareness of the range and activity of illness in
  primary care.

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What does PCCIU do now?

• SPICE, including QOF
• 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. MCS
• Develop data transfer methods paper, floppy
  disk, email
• Import to PCCIU databases
• Reports
• feedback, comparative reports - practice, LHCC,
  regional, national
• consented practice identified e.g LHCC
• in practice patient identified e.g. finding
  research subjects

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Complementary datasets

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

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Example SPICE incorporating QOF
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Anonymised, secure dataconfidentiality,
security, data protection

• Patent 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)
• Standard operating procedures
• Physical security
• Information security (e.g. only 1 practice in an
  LHCC report)

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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!