Sharing information across local health economies Dr Phil Koczan

Sharing information across
local health economies
Dr Phil Koczan
Clinical Lead NHS London Programme for IT
Clinical Informatics Lead ONEL
4th November 2010
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Overview of Health Analytics System
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Development started within Redbridge
7 different clinical systems
Well developed polysystems
Started with risk stratification
Significant potential to support improvement in care
Enabled by Aligned Data
• Encrypted at GP source
• Aligned and patient focused data
for primary and secondary care
data across the all practices
GP
Systems
• Risk Stratification
Stratify Data
Warehouse
– Computes patient risks
Journal entries
– Provides “risk aware” analysis
tools for GP and PCT staff
SUS records
• Pathway focus and financial
tracking
Users
• Practice Managers
• Polysystem Managers
• PCT Staff
PCT
Databases
Community
Services Records
Community
Records
Assessing needs and opportunities
GPs identify need and design care model
Example project – Integrated Care
Now:
Top 1% of high cost and high risk patients – 2,500 people
Every year:
• 16 x GP appts
• 8 x Outpatients
• 5 x A&E,
• 2 x hospital admissions
• 0 community nurse
Uncoordinated care and poor patient experience
costing 15% of annual PBR budget – circa £36m
Example project – Care Management
From 10/11:
Top 1% of high cost and high risk patients – 2,500 people
Integrated data and information
Individualised care packages
Combining primary, community and specialty care
Tracking care inputs and monitoring agreed outcomes
Delivery Quality and Productivity improvements
COPD Project
Agree local pathway
Code GP templates to facilitate data capture
Report with Health Analytics
Look at changes in activity
Important to develop alongside:• Education and training
• Commissioning of services
• Appropriate care of patients low risk vrs high risk
Data extraction and controls
Use of existing SUS data feeds
GP data Is extracted using MIQUEST queries
Sent via secure FTP to PCT hosted server
RBAC controls
Limits on who can see patient identifiable data
Information Governance Issues
Is patient consent required to do this work?
If deemed to be for the primary purpose of care and treatment of the patient
and disclosures would be to those who would normally have legitimate
access to the data for this purpose then consent is not required
Does using data for identifying patients at risk constitute a secondary use?
Does it matter what system is used (GP system vrs Data Warehouse?)
Do admin staff running community based services (eg retinal screening) have
legitimate access to patient identifiable data?
Information Governance Issues
Are RBAC rolls within the database sufficient
Roll of pseudonymisation
Data from sources
Community data
Social care data
Options for consent across the population
Use of data for research?
Future Potential
Greater need to combine data for provision of care
Provide support for the white paper aspirations of better integration of care,
especially Long Term Conditions
Improving quality, avoiding duplication reduce costs
Make sure the right patents get the care that they need.
Support commissioning
Summary
We need a shared understanding of the issues with clear guidelines and
removal of ambiguities
Standardised approach to data sharing and understanding of when consent is
required and how to obtain it
Balance between the needs of the NHS, needs of the patient and confidentiality
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Thank you for listening.
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