NHS Data Model and Dictionary Service Open Day

1
(No Transcript)
2
Welcome

• NHS Data Model and Dictionary Service Open Day

3
Aim of the Day

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

4
Topics for Discussion

• Welcome and introductions
• Context and overview of the service
• Current work areas
• Renal
• 18 weeks
• Commissioning Data Set 6 including the schema
• Lunch around 1230

• Open discussion
• Your own queries
• Review of the day
• Close no later than 330pm

5
Some Ground Rules

• This will be very short, and very boring if we
  talk and you listen - challenge us!
• Feel free to get up for more refreshments or to
  stretch your legs
• We will discuss current work - this is our
  direction of travel, not definitive standards
• Your comments will not be attributed to you
• Mobile phones

6
Introductions

• Your name
• Organisation
• Has the published NHS Data Model and Dictionary
  improved?

7
The team
8
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 Data Dictionary

9
NHS Data Model Dictionary ServiceThe Team

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

10
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 on a post it
• Please note that the Open Day Slides will be
• available on the NHS Data Model and
• Dictionary Service website
• http//www.connectingforhealth.nhs.uk/systemsandse
  rvices/data/datamodeldictionary/index_html

11
Context and Overview of the Service

• NHS Data Model and Dictionary Service
• Review of Central Returns (ROCR)
• NHS Information Standards Board (ISB)
• Data Dictionary release cycle

12
NHS Data Model and Dictionary ServiceCustodians
of the NHS Data Model Dictionary

• Help users read and understand it
• Publish it
• Identify changes to it
• Help desk
• Open days
• Training course

• Help policy leads change it

13
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

14
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

15
NHS Data Model and Dictionary Service

• CDS and MHMDS Message Schema
• More of these, later

16
Does the NHS work?
17
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

18
Data Model

• The model is
• Logical, not physical
• Items useful for reporting, not collecting
• Outputs, not inputs

• Unified Modelling Language (UML)
• Classes
• Attributes
• Data Elements
• Business definitions

19
NHS Data Dictionary

• Defines the components of the model

20
(No Transcript)
21
http//www.datadictionary.nhs.uk
22
Data Dictionary Navigation Options

• Data Collections
• Commissioning Data Sets
• Supporting Data Sets
• Clinical Data Sets
• Central Returns
• Diagrams
• Definitions
• Search
• All Items Index
• Data Set Change Notices (DSCNs)

23
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

24
NHS Data Model and Dictionary Service Website

• http//www.connectingforhealth.nhs.uk/systemsandse
  rvices/data/datamodeldictionary/index_html
• It holds
• The NHS Data Dictionary
• Definition Requests
• Link to Data Set Change Notice Website
• Mailing List
• Consultation Website
• XML Schemas
• News
• Useful Links

25
Consultation Website What is it?

• View NHS data standards during development stages
• Review and comment on work in progress
• Discuss work with the NHS DMDS team

26
Consultation Website Example Sites

• 18 weeks
• AE
• Admin codes
• CDS V6
• Clinic Types
• Mental Health Minimum Data Set

27
Consultation Website Access

• Email
• datastandards_at_nhs.net
• Note Users granted access to the Consultation
  Website are automatically added to the NHS DMDS
  Mailing List

28
Context and Overview of the Service

• NHS Data Model and Dictionary Service
• Review of Central Returns (ROCR)
• NHS Information Standards Board (ISB)
• Data Dictionary release cycle

29
Change Process

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

30
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

31
What is the NHS Data Model and Dictionary Service
(DMDS)?
Government Policy ROCR Request Helpdesk etc..
Update Dictionary
Identify Issue
Approved
Rejected
Identify Sponsor Stakeholders
Change Rejected
ISB
Business Analysis and Data Modelling
Resubmit / Conditional approval
Consultation Process
Early liaison with ISB
Draft Change Paper
Further Analysis
32
Change Process

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

33
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

34
Context and Overview of the Service

• NHS Data Model and Dictionary Service
• Review of Central Returns (ROCR)
• NHS Information Standards Board (ISB)
• Data Dictionary release cycle

35
NHS Data Dictionary Release Cycle

• The NHS Data Dictionary is updated once changes
  pass their implementation date
• Often this includes April and October
• May include other months, for example June 2006
• Each item is independently version controlled
• The history of every change is included with
  every item

36
Notice

• Implementation date
• Immediate
• Last month
• Six months ago
• In six months time
• In two years

• Changes to dictionary
• Late
• Very late!
• Realistic for small changes
• A big one! - 18 weeks ..

37
Topics for Discussion

• Welcome and introductions
• Context and overview of the service
• Current work areas
• Renal
• 18 weeks
• Commissioning Data Set 6 including the schema
• Lunch around 1230

• Open discussion
• Your own queries
• Review of the day
• Close no later than 330pm

38
Developing the National Renal Data Set
39
National Renal Data Set

• Whats covered (by section)

Data Items
40
National Renal Data SetPrescribed Items

• Section has 128 data items
• Distilled to 6 Elements 1 Supporting
  Information page
• Start of a linking prescribed items to SNOMED

41
National Renal Data SetRenal Care (observations)

• A more complex example
• Representing observations (height, weight, blood
  pressure etc.)
• Each observation may have different units
• Use of hover text

42
Topics for Discussion

• Welcome and introductions
• Context and overview of the service
• Current work areas
• Renal
• 18 weeks
• Commissioning Data Set 6 including the schema
• Lunch around 1230

• Open discussion
• Your own queries
• Review of the day
• Close no later than 330pm

43
Measuring 18 weeks

• Changes for a sustainable approach

44
Aim

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

45
(No Transcript)
46
What are we trying to measure?

• Lets look at some pathways

47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
The strategic approach

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

56
A worked example - Referral
57
A worked example - Appointment
58
A worked example - Attended
59
A worked example - X-Ray booked
60
A worked example - X-Ray attended
61
A worked example - Decide to admit
62
A worked example - TCI given
63
A worked example - Admitted
64
Topics for Discussion

• Welcome and introductions
• Context and overview of the service
• Current work areas
• Renal
• 18 weeks
• Commissioning Data Set 6 including the schema
• Lunch around 1230

• Open discussion
• Your own queries
• Review of the day
• Close no later than 330pm

65
Lunch
66
Topics for Discussion

• Welcome and introductions
• Context and overview of the service
• Current work areas
• Renal
• 18 weeks
• Commissioning Data Set 6 including the schema
• Lunch around 1230

• Open discussion
• Your own queries
• Review of the day
• Close no later than 330pm

67
Evolution of CDS Messages

• 1974? - 2010

68
(No Transcript)
69
(No Transcript)
70
(No Transcript)
71
(No Transcript)
72
NWCS has been decommissioned

• CDS Version 4 retires imminently

73
Data Validation

• NWCS - CDS Version 4
• Checked some field sizes
• Checked some formats
• Checked for some mandatory fields

• XML - CDS Version 5
• Checks field size
• Checks format
• Checks permitted values
• Checks fields based on content of other fields

74
Commissioning Data Set Messages
Spine
Provider
75
(No Transcript)
76
(No Transcript)
77
Scope

• Current scope is commissioning data for
  Inpatients, Outpatients and AE
• Scope should be expanded to include additional
  data required for secondary uses CDS renamed
  Secondary Uses Data Sets
• Outpatient data set should be extended to cover
  any activity other than IP / AE e.g.
• Outpatients (e.g. consultant, nurse led, AHP,
  midwife OPS)
• contacts (e.g. district nursing)
• transport (e.g. ambulance, neonatal transfer)
• Diagnostic investigations (e.g. imaging and
  audiology)

78
Protocols

• Submissions are currently made using the bulk
  update and net change protocols
• Bulk update does not easily support many systems
  feeding a single data set from a provider
• Either many types of the outpatient CDS message
  will be required to support many types of system
• Or outpatient activity is limited to the net
  change protocol
• The inpatient CDS could move to be a spell based
  data set

79
Record Linkage

• The data dictionary has activity groups to link
  related activities
• Examples include consultant episode, Spell etc.
• The CDS has very limited support for linkage
• In order to enable Referral to Treatment pathways
  and periods to flow, linkage will be revisited
• Activities will be able to be recorded as
  sub-activities, for example an X-ray as part of a
  clinic appointment

80
Record linkage
AE
OP
AE
OP
IP
OP
?OP
?OP
?OP
OP
AE
IP
IP
OP
81
(No Transcript)
82
Administrative content

• Administrative data items will be reviewed to
  ensure continued fitness for purpose
• E.g. Source of referral exists with eight
  different definitions and value lists (which
  could rise to 10 with work in progress)

83
Clinical Content

• Current Clinical content
• classifications (ICD, OPCS), secondary data
  items (e.g. AE Investigations) and the Read
  terminology
• Many clinical domains do not have pre-existing
  classifications
• It is possible to enable SNOMED CT to flow within
  the data sets
• SNOMED CT will need to flow within its clinical
  context, e.g. as clinical statements

84
(No Transcript)
85
(No Transcript)
86
Commissioning Data Set Schema
87
like a fine wine
Our data is precious
Be sure we know what it is
We need good packaging
We need to protect it
88
The schema is the packaging

• It protects the data
• It ensures the data doesnt deteriorate
• The packaging is designed to take specific data
  items
• It is designed not to take invalid or illogical
  data

89
(No Transcript)
90
The schema is like an MOT test

• You dont have to include a spare wheel
• But if you do
• and it does not pass,
• the whole car fails

91
Exploring the schema

• Commissioning Data Set Version 6

92
(No Transcript)
93
Opening the Schema documentation
Main entry point
The base type definitions
94
Message groups
Contains one of each of the components
Each bulk update group contains one or more
messages
Can have one and only one message group
95
Header
Net Change message group
A bulk update group
The Net Change message group can contain one or
more messages
96
A trailer
97
Summary of the Interchange structure

• Each Interchange must contain
• A header
• One (and only one) message group
• Net change message group
• A bulk update group
• A trailer

98
Summary of a message group

• Each message group can contain
• One or more messages

99
Each net change message can be any CDS type
100
All the messages in a bulk update group are from
a limited set of CDS types
101
(No Transcript)
102
Summary of each message

• Each message contains
• A message header
• A transaction header
• A CDS type (holding the content)
• A message trailer

103
Exploring a CDS type

• CDS Type 130
• Admitted Patient Care
• Finished
• General Episode

104
(No Transcript)
105
Looking at some CDS types
106
Care Activity and Future Care Activity
They look identical
107
Person Group Patient - Care Activity
All the content is optional
108
Patient Identity - General Structure
If you choose to use the Patient Identity General
Structure
you must include a validated NHS Number
structure or an unvalidated NHS Number
Structure
109
Where is this used?

• PersonGroupPatient_General_Structure
• PersonGroupPatient_Psychiatric_Structure
• PersonGroupPatient_AAndE_Structure
• PersonGroupPatient_CareActivity_Structure
• PersonGroupPatient_EAL_Structure

110
Validated NHS Number
NHS Number Status must be 01
All the content is mandatory
Name and address are not included
111
NHS Number Status must not be 01
Only NHS Number Status is mandatory
Name and address are included
112
Back to the top of Type 020
113
Care Attendance
114
(No Transcript)
115
The Appointment Date is key it is the CDS
ACTIVITY DATE
Most elements are entirely optional
A default date exists for future care activity
without a scheduled date
Where new standards are introduced the business
rules have stronger controls
Very General Purpose fields exist but are not
output by SUS
116
Common types are used to make maintenance easier
type AdministrativeCategory_Type properties is
Ref 0 minOcc 0 maxOcc 1 content
simple facets totalDigits 2 enumeration
01 enumeration 02 enumeration
03 enumeration 04 enumeration
98 enumeration 99 annotation documentation
ltMandatorygtMlt/Mandatorygt ltU_A/gt ltHES/gt
MaxOcc indicates the maximum number of fields
permitted. In this case just 1.
minOcc indicates whether the field must be
present (if the containing structure is present).
minOcc 0 indicates it is optional
Only the listed values are permissible. An
invalid value would invalidate the whole
interchange
Data Dictionary business rules are shown as
annotations. They do not describe the XML rules!
117
Back to the top of Type 020
118
(No Transcript)
119
Its a common structure
so it includes the AE diagnosis scheme as
being possible in the XML
120
The coding schemes are mandatory if the structure
is used
A Primary Diagnosis is mandatory if the structure
is used
Any number of secondary diagnoses are permitted
in Commissioning Data Set 6
121
Summary

• The XML schema protects data integrity
• Most items are not required
• Where items are used they must be valid

• Some data items are XML mandatory
• Business rules are enforced more stringently on
  new data items
• The documentation is easier than it looks!

122
Conclusion

• You may need a glass or two
• just to remind you
• the schema protects the integrity of the data

123
Open Discussion
124
Your Queries
125
Review of the day

• Please complete the Evaluation Form