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Welcome
NHS Data Model and Dictionary Service
Open Day
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Aim of the Day:
To enable users to discuss the
NHS Data Model and Dictionary
with the National team
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• Introductions• Overview of the "Introduction to the NHS Data Model and
Dictionary" Training Course • Role of the NHS Data Model and Dictionary Service • Change Process• NHS Data Model and Dictionary Service Website • NHS Data Model and Dictionary Service Consultation Website• Navigation of the NHS Data Model and Dictionary • Lunch around 12:30• Using a Patient Pathway for Outcome Analysis • Measuring 18 weeks • Commissioning Data Set Version 6 • Open Discussion• Review of the day• Close no later than 3:30pm
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Introduction to the NHS Data Model and Dictionary Training Course
• Objective:
Develop a greater understanding of the NHS Data Model and Dictionary
• Target Audience:
NHS Information professionals in Trusts, PCTs and Health Authorities
• Delivery:
2 day course based in Leeds, 6 times a year
Next course October 2007 in Leeds
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Course Content
The training course includes presentations on the following topics:
• Background • Data Standards • The Change Process • NHS Data Dictionary • Data Validation • Data Modelling • Data Definition Queries
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Course Content
On successful completion of the course, participants will be able to:
• Understand the need for Data Standards• Understand how to navigate the NHS Data
Dictionary• Read a Data Model• Use the NHS Data Dictionary to resolve data
definition queries
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NHS Data Model and Dictionary Service Products
NHS Data Model and Dictionary
NHS Data Model and Dictionary
NHS Data Model and Dictionary Website
NHS Data Model and Dictionary Website
NHS Data Model and Dictionary Consultation
Website
NHS Data Model and Dictionary Consultation
Website
Frequently Asked
Questions
Frequently Asked
Questions
Training Courses
Training Courses
Open Days
Open Days
Query Resolution
Query Resolution
Mailing List
Mailing List
Supporting Development
Supporting Development
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Role of the NHS Data Modeland Dictionary Service
Custodians of the NHS Data Model & Dictionary
• Help users read and understand it: Helpdesk Open Days Training course
• Publish it• Identify changes to it• Help policy leads change it
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NHS Data Model and Dictionary
•Well established•English•National•StandardEnabling PolicyTo be implementedThroughout the NHS
Policy examples• Purchaser / Provider• Casemix• Commissioning• Waiting lists• New ways of working• Treatment functions• National Service
Frameworks
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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
CDS
ClinicalRecordAdmin
record
ClinicalData set
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NHS Data Model and Dictionary Service
• Commissioning Data Set and Mental Health Minimum Data Set Message Schema
More of these, later
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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
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Change Process
• Driven by policy• Often involves multiple Data Set Change
Notices (DSCNs)• Notification• Review of Central Returns (ROCR)
mandate• Dictionary update• Commissioning Data Set Changes (CDS)• Message schema changes
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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
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Government PolicyROCR RequestHelpdesk etc..
Update
Analysis
Stakeholders
Issue
Draft
Consultation
FurtherAnalysis
Early liaison
with ISB
Approved
Resubmit / Conditional approval
Rejected ISB
What is the NHS Data Model and Dictionary Service (DMDS)?
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Change Process• Operational standards are approved by NHS
Information Standards Board• Standards must have the following defined before
they are approved:• Scope and purpose• Department of Health policy sponsor• Customer need• Implementation plan including testing and
training• Business justification• Risks• Research into existing similar standards• Interdependencies and interoperability
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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
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http://www.connectingforhealth.nhs.uk/systemsandservices/data/datamodeldictionary/index_html
• It holds:• News• NHS Data Model and Dictionary• Help (Frequently Asked Questions) (Updated)• Events (New)• Mailing List• Consultation Website• Publications (New)• XML Schemas• CDS Supporting Information (New)• Link to Data Set Change Notice Website• Useful Links (Updated)
NHS Data Model and Dictionary Service Website
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• Check the NHS Data Model and Dictionary
• Look at Frequently Asked Questions
• Search other websites (e.g. ISB etc)
• Contact other Help Desks (e.g. SUS etc)
Options for ResolvingData Definition Queries
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Data Definition Queries
Data Standards and Products Helpdesk:[email protected]
• full name• job title• telephone number• full postal address • organisation code (if you are an NHS user)• suggested resolution
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Consultation Website: What is it?
• View NHS data standards during development stages
• Review and comment on work in progress
• Discuss work with the NHS Data Model and Dictionary Service
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Consultation Website: Example Sites
• 18 weeks• Quarterly Monitoring: Accident and
Emergency Services (QMAE)• Commissioning Data Set V6• Mental Health Minimum Data Set• Removal of EDIFACT• Genitourinary Medicine Access Monthly
Monitoring Data
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Consultation Website: Access
Email:[email protected]
Note: Users granted access to the Consultation Website are automatically added to the NHS Data Model and Dictionary Service Mailing List
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Data Model Components
NHS Number
NHS Number (Baby)
NHS Number (Mother)
Carer Support Indicator
Data Elements
Local Patient IdentifierOrganisation Code (Local Patient Identifier)Organisation Code TypeNHS NumberBirth Date
Accident and Emergency Attendance
Organisation Code (Code of Provider)Organisation Code (Code of Commissioner)Reporting Period (Mental Health)NHS NumberElectoral Ward of Usual Address
Mental Health Minimum Data Set
Data Sets
PATIENT
ACTIVITY
Classes
for
Subject of
1
0..*
Relationship
K NHS Number Carer Support Indicator Carer Permission Date Chronically Sick or Disabled Drug Misuse Database Number …..
K Activity Identifier
Attributes
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•Data Collections• Commissioning Data Sets• Supporting Data Sets• Clinical Data Sets• Central Returns
•Diagrams•Definitions•Search•All Items Index
Data Dictionary Navigation Options
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NHS Data Dictionary Release Cycle
• The NHS Data Model and Dictionary is updated once changes pass their implementation date
• Often this includes April and October• May include other months,
for example August 2007• Each item is independently version
controlled• The history of every change is included with
every item
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Intelligent use of information
to hit Nicholas Oughtibridge,
the aim as well as the target
Using a Patient Pathway for Outcome Analysis
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Intelligent use of information
to hit Nicholas Oughtibridge,
the aim as well as the target
NH
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First consultant out-patient appointment• 13 weeks
Waiting for elective admission• Six months
Arrival to discharge at A&E• Four hours
Practice and GP Access• 24 / 48 hours
G U Medicine• 48 hours
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Complex definitions
• Suspensions• Deferrals• Reasonable offers• Patient
cancellations• Hospital
cancellations• DNA• CNA
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Most queues have been hidden!
• Out-patient following emergency
admission A&E attendance
• Endoscopies Except direct
access GP referral Admitted
• Ready for discharge
• Audiology• Mental health• Clinical Assessment• GPwSI• Follow up clinics• Non-consultant
clinics• Imaging• Non-GP referral
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Key features
• Regular flow
• Predictable peaks in demand
• Each stage is connected to the previous and the next
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Traditional measurement
• Concentrates on start and end
• Misses out many stages in the middle
• Counts activity and people queuing for activity
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Traditional measurement
• Measure Stations
• Counts activity and queuing for activity
• Ignores• the destination• the journey• time
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Minimise hidden waits
• Measure from referral to the start of treatment designed to resolve the patient’s problem or condition
• Take the opportunity tounderstand patient journeyslook beyond the target
(First Definitive Treatment)
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Problems …
• An incident in one place can have an impact on the whole service
• The flow has to find alternative routes
• Difficult to manage• Difficult for customers
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Problems
• An incident in one department can have an impact on the whole service
• The flow has to find alternative routes• Difficult to manage• Difficult for patients
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Mornington Crescent
The game is intended as a parody of complicated strategy games, and particularly satirises the complex rules and terminology that evolve around games such as contract bridge or chess.
Wikipedia
The Mornington Crescent tube station is on London's Northern Line between Euston and Camden Town on the Charing Cross Branch.
However, if you travel between the same two stations on the City Branch, the station simply isn't there. Now you see it, now you don't.
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Mornington Crescent
But is it all just a game …
I’m sorry. I haven’t a clue!
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Primary Care Zone
Secondary Care Zone
Chronic and recurrent conditions
Definitive Treatment
Em
erg
ency
M
edic
ine
GP
Wri
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ref
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a
Clin
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Ass
essm
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Cen
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District Nursing
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GP Written referral• Home• GP• Consultant first• Diagnostics• Consultant follow up• Treatment• Follow up• Discharge• Home
GPwSI or CAS• Home• GP• GPwSI or CAS• Diagnostics• Consultant first• Treatment• Follow up• Discharge• Home
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Isolation – barrier to success
• No department is isolated
• Patients are referred
In
Out
• Inter-departmental referrals
make the patient journey
• Departments may be in
different providers
Analyse the flow
Identify the blockages
Measure the variation
Spot surplus capacity
Link outcome to the journey
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Understand the flow
• Link the whole patient journey• Concentrate on the patient experience• Understand patient choices• Use scheduled activity – identify scheduled
problems Don’t plan to fail
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Core techniques to managewaiting lists
• Validation• Primary Targeting lists• Eliminate unnecessary queues• Eliminate unnecessary steps / activities• Schedule likely events in advance• Measure capacity in appropriate units
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Validation
• Ensure the people you think require treatment are willing and available to have treatment
• 18 month target was achieved using validation
• Available includes • patient choice of treatment• clinical availability / suitability
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Primary Targeting Lists
• A list of the patients needing treatment in order
• Historically effective for stage of treatment• Major contributor to 12 month and 17
weeks targets
• Still relevant• Now need to look at the whole pathway
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Eliminate unnecessary queues
• Reducing queues reduces the variability in treatment time
• Queues should be for different streams / processes
• Queues should not be for arbitrary administrative reasons
• Eliminate “back doors” to treatment which allow queue jumping by those in the know
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Plan ahead
• Book known or anticipated stages in advance
• Schedule activities on the same day where possible
• Allow patients to choose mutually convenient slots where possible
• Schedule resources as well as people
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Measure in appropriate units
Clinic time required Clinic slots required Bed days anticipated Theatre hours used Scanner time required Equipment required
Use the same units for activity, backlog, capacity & demand
Number of first consultant led appointments
GP Written referrals received
Finished Consultant Episodes
Patients waiting Patients seen last
month
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Key statistics
• 2.671 million journeys per day
• 3.009 million passengers use the 2 platforms at Mornington Crescent per year
• 77.564 million passengers use the 8 platforms at Kings Cross per year
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Outcome analysis
• By looking at the patient pathway early interventions can be assessed in terms of outcome
• Adherence to care pathways can be assessed
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Measuring 18 weeks
Changes for a sustainable approach
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Aim
To define and measure the length of wait from GP referral to first definitive treatment
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Patient
What are we trying to measure?
Lets look at some pathways
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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Clinical Assessment Attendance
Walk in centreattendances
Outpatient attendances
Radiologyinvestigations
Physiological Measurements
Elective Admissions
Emergency Admissions
Accident and Emergency
attendances
GP Attendances
Patient
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The strategic approach
• Measurement using the CDS• Patient Pathway Identifier to link records• Referral to Treatment Period Status to
identify the anticipated or final status of each activity
• Referral to Treatment Period Start Date and Referral to Treatment Period End Date
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A worked example - ReferralCDS ID Activity
DateStart End Status
021 1 9/1/07 10
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A worked example - Appointment CDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
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A worked example - AttendedCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
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A worked example - X-Ray bookedCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
021 1 31/1/07 9/1/07 20
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A worked example - X-Ray attendedCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
021 1 31/1/07 9/1/07 20
020 1 31/1/07 9/1/07 20
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A worked example - Decide to admitCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
021 1 31/1/07 9/1/07 20
020 1 31/1/07 9/1/07 20
030 1 9/1/07 30
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A worked example - TCI givenCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
021 1 31/1/07 9/1/07 20
020 1 31/1/07 9/1/07 20
030 1 9/1/07 30
030 1 19/3/07 9/1/07 30
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A worked example - AdmittedCDS ID Activity
DateStart End Status
021 1 9/1/07 10
021 1 24/1/07 9/1/07 10
020 1 24/1/07 9/1/07 10
021 1 31/1/07 9/1/07 20
020 1 31/1/07 9/1/07 20
030 1 9/1/07 30
030 1 19/3/07 9/1/07 30
130 1 19/3/07 9/1/07 19/3/07 30
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Topic DSCN Publish Collect from
Submit from
Paediatric Critical Care 01/2007 Feb '07 Apr '07 Dec '07
Neonatal Critical Care 15/2006 Aug '06 Apr '07 Dec '07
Age 08/2007 Apr '07 Oct '07 Dec '07
Discharge Ready Date 13/2007 May '07 Oct '07 Dec '07
Patient Pathway 18/2006 Dec '06 Jan '07 Dec '07
Referral to treatment periods 18/2006 Dec '06 Jan '07 Dec '07
Earliest Reasonable Offer Date 09/2007 Apr '07 Oct '07 Dec '07
Diagnostic data flow 02/2007 Feb '07 Oct '07 Oct '07
CDS 5 refresh With ISB Ongoing Oct '07
CDS 6 XML schema 14/2007 Jun '07 (message) Dec '07
CDS 6 tables 18/2007 May ’07 (message) Dec ‘07
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Timetable - submission
Topic Implement Mandated
Diagnostic data through out-patients Dec '07 Apr '08
Elective Admission List Apr '08
Future Out-patient appointments Dec '07 Apr '08
Use of net change protocol Use of CDS 6
Retire Commissioning Data Set 4 Jul '07
Retire Commissioning Data Set 5 Apr '08
Timely submission (within 4 days of change) Apr '08
Secondary Uses Service extracts Dec '07
Enhanced reporting for commissioners To be confirmed
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Commissioning Data Set Purpose• Allows organisations to receive activity level
data• Supports Commissioning• Feeds Hospital Episode Statistics• Covers
• Past, current and future admitted patients including day case, long stay and psychiatric
• Past and future out-patients including ward-attenders, nurse/midwife/therapist and diagnostics
• Past Accident and Emergency attendances
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Commissioning Data Set Version 6
• Evolution over 15 years, not revolution
• Move to re-use common components
• Summary of time-table• Notice of change published in May '06• Schema and Tables published May ’07• Expected to be mandatory April ‘08
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Commissioning Data Set 6
• XML – protects the integrity of the data• Commissioning Data Set 5 has proved challenging
to some providers
• Prevents invalid data for almost all fields• Exceptions include NACS, ICD, OPCS, READ
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Categorisation of Data Quality
Missing
Default Other
Invalid
Valid
Data
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Categorisation of Data Quality
Missing
Default Other
Valid
Data
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If the admission is in a series of regular day or night admissions
Then use either National Code 0 or 1
Otherwise, don’t send the field
NH
S D
ata
Mo
del
an
d D
icti
on
ary
Ser
vice A numberA number
Values 0 or 1Values 0 or 1
One digit longOne digit long
NH
S D
ata
Mo
del
an
d D
icti
on
ary
Ser
vice
Main New Content
• PbR• Paediatric and
neonatal critical care
• Discharge ready date
• Age
• 18 Weeks• Pathway identifier• RTTP data items• Future out-
patients• Earliest
reasonable offer date
NH
S D
ata
Mo
del
an
d D
icti
on
ary
Ser
vice
Big impact - Content
• Future out-patients• Elective Admission List• Critical Care• Patient Pathways• Referral to treatment periods• Diagnostic systems
NH
S D
ata
Mo
del
an
d D
icti
on
ary
Ser
vice
Big impact - Submission
• Frequency moving to “within 4 days of a change”
• Net change protocol for all routine submissions
NH
S D
ata
Mo
del
an
d D
icti
on
ary
Ser
vice
Review of the day
Please complete the Evaluation Form
