“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

HampshireClinical Repository

Hugh SandersonHead of Clinical Information Development

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• What is it• What does it look like• Clinical feeds/ Date entry• Security and consent• Database• Potential for Clinical Indicators

Overview

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

A browsable combined patient record with extracts of:

• GP record• Hospital records

Additional record fields for:• Single assessment process• Cancer data • Occupational Therapy

Linked pseudonymised database for analysis

What is it?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Clinical Record

Anonymised

database

CDR

Patient Index

200+ GP practices

WinchesterPortsmouthSouthamptonNorth HantsTrust

sPAS, Pharmacy,Patholog

y,Radiology, Cancer Databases,Clinical letters

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Exeter Data entry screens

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“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Based on experience of an ERDIP pilot study in Central Hampshire:– BMJ April 2004

• Interim solution to exploit legacy systems which will be replaced when NPfIT provides similar functionality

Why are we doing it?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Better emergency care in A&E, Out of Hours Service, drop in centres

• Better coordinated care between hospital, GP, Community and Social Services

• Better information for planning and monitoring and audit based on the whole patient journey.

Benefits

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Single assessment process

• Occupational Therapy

• Cancer MDT records

• Can be partially completed and updated later• Drop down menus and date selection

Direct data entry

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• PHT MAU• PHT Outpatient Appt. (inc IOW)• PHT QA CT Scan• PHT QA Fluoroscopy• PHT QA Medical Physics• PHT QA MRI Scan• PHT QA Nuclear Medicine• PHT QA Ultra Sound• PHT QA X-ray• PHT RHH Biochem/ Haematology• PHT RHH Blood Transfusion• PHT RHH Histology• PHT RHH Microbiology• PHT RHH MRI Scan• PHT RHH Ultrasound• PHT RHHX-Ray

• SUHT Biochemistry• SUHT Correspondence• SUHT Haematology• SUHT Histopathology• SUHT Immunology• SUHT Medical Microbiology• SUHT Virology

• WEHT Allergies/alerts• WEHT A&E discharge• WEHT IP Discharge• WEHT OP appointment• WEHT IP prescribing• WEHT wait listing

Hospital Feeds

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Clinical Repository Advisory Group• GPs• Acute Hospital / Primary Care Trusts• Mental Health Trust• Patients/ Carers• LMCAdvise on security arrangements and data analysis

requests and information to the community.

InformationGovernance

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Explicit consent required each time before record can be viewed unless previously agreed ( = Opt in)

• Public information campaign through leaflet distribution

• Patients can opt out of Common Health Record• Staff role determines type of access • Read codes only downloaded from GP record• Audit trail to record who has looked at which

record and when• Patients have the right to see the audit trail and

their record.• Pseudonymised data analysis

Consentmodel

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Samples from the Central Hampshire pilot

• Early results of analysis from Hampshire

Data Analysis

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Post operative wound infections

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1

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WEHT OtherTrust

GP

GP dataWEHT data

• Post op infection rate using hospital data = 0.4%

• Post op infection rate

using hospital and GP

data = 3.2%

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Chronic diseaseMonitoring

Of 92 patients with diabetes:

– 1,987 lab results for 49 patients– 511 by GP, 1,476 by consultants, (225

in OP dept )– 40 HBA1 tests on 34 patients – 27 done by GP, 13 in Outpatients– 57% of results were above normal limits

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

BP Control Mean (months) Patients

No H/T 35.7 403,861

Good 11.6 152,940

Poor 18.1 34,546

Total 28.4 591,347

76% of those with poor control had a BP in 2005 or more recently, 89% of those with good control did.

BP Control

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Linked primary and secondary care records.

• Records of events ( OP, A&E, Admissions, Discharges, procedures, radiology, etc)

• Numerical values for laboratory/ clinical measures.

• Diagnosis and procedure codes

• Feeds from existing clinical data systems and data set submissions.

Value for clinical Indicators

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

• Coverage of all practices/ trusts/ independent providers.

• Data quality ( especially GP records)

• Comparability of lab results.

• Security, confidentiality and Information governance.

• Distributed analysis service

Ongoing Issues