The Secondary Uses Service SUS

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The Secondary Uses Service (SUS)
Joint NCRI Informatics caBIG Conference 13 Jul
07
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Information Centre Services

• ASCID - adult social care information development
  
• Casemix - develops Healthcare Resource Groups
  (HRGs) to support Payment by Results (PbR)
• Health Informatics - standards in collection,
  management and use. Maintains the Skills for
  Health framework
• HES - details of all admissions to hospitals in
  England via Commissioning data
• Information Governance - the legal and ethical
  use of data
• National Clinical Audit Support Programme -
  audits on major diseases
• National Datasets Service - defining the data
  items, mapping to classifications (ICD-10,
  OPCS-4) clinical terminology (SNOMED-CT) coding
  
• Primary Care Statistics - statistics on GPs and
  dentists
• Prescribing Support Unit  - data and consultancy
  services on prescribing
• Review of Central Returns (ROCR) - data
  collections coordination
• Statistics Publications - regular statistical
  reports publications
• Secondary Uses Service (SUS) - secondary uses of
  NHS Care Record data

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GENERIC MODEL - END TO END IMPLEMENTATION OF
DATASETS
NHS Wide secondary uses
Local secondary uses
Direct Care use
Access to comparative analysis
Use of data in provision of care
Access or extract data
Capture of data
Standards for data items maintained in local care
records
Standards for data items included in local
extracts and in local analysis systems
Standard content and schema for NHS wide data
flows
Data standards must be supported by LSP reference
solutions and existing systems
Data standards must be supported by LSP reference
solutions and existing systems
LSP reference solutions and existing systems must
be capable of producing extracts. SUS must be
capable of receiving, managing and providing
access to data and analyses

• Issues to be considered
• LSP reference solution development
• and release schedules
• Capability of existing analysis
• systems and funding for changes

• Issues to be considered
• LSP reference solution development
• and release schedules
• Capability of existing systems and
• XML services and funding for changes
• SUS release schedules and funding
• for development

• Issues to be considered
• LSP reference solution development
• and release schedules
• Capability of existing systems,
• funding for changes
• Implementation support necessary

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Secondary Uses Service

• A repository of care data for use in care
  planning, policy development, performance
  management, clinical audit and medical research.
• SUS will provide
• A consistent environment for data management,
  allowing better comparison across the sector
• Protection of confidentiality through rigorous
  access controls and removal of patient indicators
  from data transferred from the warehouse
• Access to timely data to analysis and reporting
  tools
• Better data accuracy and a reduction in the
  burden for the NHS by extracting data from other
  operational sources where possible, simplifying
  submission processes and carrying out checks on
  the data submitted

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History and Origin

• SUS is being delivered as part of the
• National Programme for IT (NPfIT)
• National Application Service Provider (NASP)
  supplier is BT contract awarded in December 2003
• Data are transmitted via the Spine
• Main warehouse being delivered by BT as part of
  NPfIT, managed by NHS Connecting for Health
  (CFH). The IC works in partnership with NHS CFH
  to develop and implement SUS. Particularly
  responsible for the data definition, analysis and
  reporting.
• SUS is the single NHS-wide system for processing
  Commissioning Datasets (CDS) and for extracts to
  support Payment by Results (PbR). SUS information
  is the basis of the Hospital Episode Statistics
  (HES) and Mental Health Minimum Dataset (MHMDS)
  systems.

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What is SUS Designed to do?

• SUS is designed to provide
• Pseudonymised, patient-based data
• A range of software tools and functionality which
  enable users to analyse report and present these
  data
• Enable linkage of data across all care settings
• Ensure the consistent derivation of data items
  and construction of indicators for analysis
• Improve the timeliness of data for analysis
  purposes
• SUS comprises of
• A common and consistent information governance
  model
• Access control
• Use of pseudonyms to replace identifiers
• Design elements e.g. small number suppression and
  derivation algorithms

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SUS Move to a Federated Approach
Security and confidentiality ensured by
consistent access control and design
PBC Support
Landing
Web based application for Practices, PCTs, SHAs
Staging
Universal Data Warehouse
HES
A Core Warehouse and Data Marts
PBR
NHS CDS Extract
Other Extract
Clinical Audit
Data submitted by all providers of NHS acute
and Mental Health Care
HES reports and extracts
Consistent metadata business and technical
Extracts for Non NHS organisations
Extracts and Reports to all PCTs, Trusts, SHAs
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Current Services Payment by Results

• The first priority for SUS is the implementation
  of Payment by Results (PbR) The aim of PbR is to
  provide a transparent, rules-based system for
  paying NHS Trusts for the activity they undertake
  using a national tariff
• Under PbR, payment is based on activity and
  adjusted for Casemix (more detail at
  www.ic.nhs.uk/casemix )
• PbR ensures a fair and consistent basis for
  hospital funding rather than being reliant
  principally on historic budgets and the
  negotiating skills of individual managers
• Providers and Commissioners are then given access
  to this information, providing a consistent basis
  for negotiation
• A reconciliation exercise is presently underway
  to further improve the quality of data submitted.
  Once complete, SUS is expected to be formally
  made the definitive PbR data source
• Data is currently provided to organisations but
  towards the end of 2007, an online service will
  be available, which will allow additional
  analysis facilities to be made available to
  providers and commissioners

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Current Services Practice Based Comparators

• NHS wide web-based comparators available online
  for the provision of GP practice comparators
  using SUS and QOF data
• Accessible to all GP practices, Primary Care
  Trusts (PCTs), Strategic Health Authorities
  (SHAs), other trusts and Public Health
  Observatories (PHOs)
• Provides access to information on
• Commissioning activity
• Referral patterns
• Outcomes
• Prescribing
• Quality and Outcomes Framework (QOF)

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Key issues Data Quality

• SUS is populated with NHS data ! Providers and
  Commissioners have a responsibility to make sure
  that all staff collecting, managing and collating
  data are trained and fully aware that data must
  be accurate, consistent, timely, fit for purpose
• Quality Challenges Improving the content and
  completeness of individual records. Currently
  invalid and inaccurate data
• Prevents consistent linkage of data
• Prevents commissioners accessing data
• Leads to incorrect financial payments
• Leads to misleading comparators and indicators
• Increases the unnecessary and inappropriate use
  of identifiable data
• Data Quality information is currently made
  available to users at http//www.connectingforheal
  th.nhs.uk/systemsandservices/sus/dataquality

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Key development 18 Week Programme

• CDS Version 6
• Enable 18 weeks-specific data items to be loaded
  into SUS
• Enable reporting via Extract Mart and HES
• Dataset and XML Schema defined and approved by
  ISB May 07
• Published on SUS 18 Week Programme web sites
• 18 weeks SUS application
• Linking events to give Referral to Treatment
  times
• Retrospective and Prospective Reporting
• Business Requirements produced and approved by DH
  18 Week Exec Board
• SUS Service Provider developing specification
• Flexible, easily used by non-specialists
• Range of graphical and tabular reports
• Drill down to pathway and patient event level
• Ability to set against comparator data
• Role Based Access Control to limit access

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SUS Plans for the next 12 months
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IC PROCESS - DATA INTO INFORMATION
Content XML Schema (Datasets e.g. CDS as enabler)
INPUT LSPs / existing systems capturing standards
ICD/OPCS
DATA FLOW
DATA FLOW
DATA FLOW
DATA FLOW
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And then...

• Addition of clinical data and extracts, covering
  priority areas such as cancer, diabetes, heart
  disease and renal clinical audit
• Data relating to patients prescriptions
• Data relating to the primary and social care
  provided to patients and service users allowing
  linkage of data from all care levels
• The potential uses of a database covering care
  provided at all levels across the whole of
  England are huge, with an impact on public
  health, research and development and ultimately
  on the quality of care
• At some point, SUS has the scope to expand beyond
  NHS commissioned care to include the addition of
  other person-specific data such as finance,
  workforce, estates and National Audit Office
  (NAO) information

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CLASSIFICATION INTERDEPENDENCIES
THE INFORMATION CENTRE (IC)
SECONDARY USES SERVICE (IC / CfH)
LSPs TRUSTs SHAs
18 week Reporting
CAB Reporting
DATA ITEMS e.g. ICD, OPCS
DATASETS e.g. CANCER, CDS, HRG etc.
SNOMED (READ)
Landing Staging DATA RULES
LOCAL PAS SYSTEMS
PDS Reporting
PbR Marts
REFERENCE COST GROUPER
MHMDS Mart
HES Mart
Extract Mart
Clinical Marts
CfH
DATA MODEL DICTIONARY
Clinical Feedback
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• Questions now or later ?
• Monica C M Jones
• Head of NHS National Datasets Service
• The Information Centre for health and social care
  
• monica.jones_at_ic.nhs.uk
• www.ic.nhs.uk