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Agenda

Agenda. DMICs and their place in the NHS IG landscape DMIC development project DMIC Network DMIC Technical. CSUs. CSUs and DMICs.

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Agenda

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  1. Agenda • DMICs and their place in the NHS • IG landscape • DMIC development project • DMIC Network • DMIC Technical SEPHIG 5-Dec-2012

  2. CSUs CSUs and DMICs • CSUs will provide CCGs with external support, specialist skills and knowledge, e.g. business intelligence services, clinical procurement services, business support services such as HR, payroll, procurement of goods and services and some aspects of informatics etc. to support them in their role as commissioners. • CCGs have the freedom to decide which commissioning activities they do themselves, share with other groups or buy in from external organisations. • Will be externalised in April 2016 DMICs • DMICs will collate commissioning intelligence pertaining to a number of CCGs, and provide this to other elements of the health service infrastructure including other CSUs. • The structure of DMICs is varied; some are hosted by a subset of the CSUs, others operate as collaborative shared service across a number of CSUs . • What are DMICs? • They are • The official NHS data processing and linkage orgs • Hosted by CSUs or operating as Shared Services • They are not • Virtual organisations

  3. Old-world Organisation Relationships 4 x PAN SHAs (e.g. Y52) 10 x SHAs (e.g. Q38) 151 x PCTs (e.g. 5QE) (50-ish PCT Clusters) 8,500-ish GP Practices

  4. New-world Organisation Relationships DMICs -- 0aa 1 x NHS Commissioning Board 4 x Commissioning Regions (e.g. Y57) 27 x Local Area Teams (e.g. Q69) 22 x Commissioning Support Units 9 x Data Management and Integration Centres 211 x Clinical Commissioning Groups 8,500-ish GP Practices

  5. Geography of CSUs and DMICs CCG/Practice mapping http://www.connectingforhealth.nhs.uk/ systemsandservices/data/ods/ccginterim 23 Commissioning Support Units 9 DMICs Stop press: 0AF + 0AN = 0CE NHS Cheshire and Merseyside 9 Data Management Integration Centres Indicative

  6. How intelligence will be delivered Data Flows To enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets, a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public National Provider (Local flows) National Data Feeds Provider National flows Care.data HSCIC Wider Determinants Audits Safe haven Alternative providers ONS Sub-national Conformed data supplied back up to care.data Local Data Feeds 3rd Sector National/ International Surveys DMICx ~9 Safe haven DMICs may also provide data to wider stakeholders LATs X~27 Local CSU X~23 Small no CCGs doing own intelligence LAPH X~150 CCG CCGs x~210 CCG

  7. CSU/DMIC schedule • What does DMIC operational mean? • Main issues are • Operational readiness • Data Interoperability – both ‘up’ and ‘down’ • Pseudonymisation • PbR rules • Industry liaison Apr 2013 Apr 2014 Apr 2015 Apr 2016 CSUs and DMICs operational CSU s externalised But first .. What about IG?

  8. NHS Act 2012 and IG • Tim Kelsey’s vision • Many practical issues unresolved in the Act • Section 251 needed to support flow of PID outside the HSCIC • PCTs do much more than just commissioning (e.g. Urgent Care) • Patchy implementation of pseudonymisation • Sharing data and linking it together will improve • whole system understanding • enable pathway monitoring across health and social care • identify system interdependencies • facilitate correlations between treatments, experience and outcomes • Section 251 - sets aside the common law duty of confidentiality for [direct] medical purposes • where it is not possible to use anonymised information and • where seeking individual consent is not practicable.

  9. Commissioning Intelligence Model The business intelligence needs to support health commissioners can be framed as a set of questions that need help answering. • How healthy? • What’s really happening? • How much? • How good? • Are Providers delivering? • Could things be better? • Have we made a difference? • What are our future plans

  10. Commissioning activities requiring PID The seven scenarios where Commissioners need access to PID Integrated care and monitoring services including outcomes & experience requires linkages across sources Commissioning the right services for the right people requires the validation that patients belong to CCGs and have received the correct treatments Aspects of service planning and monitoring on geographic data basis require postcodes for certain type of analysis Understanding population and monitoring inequalities Target support for patients and population groups at highest risk requires data from several sources linked together Specialist commissioning is commissioned outside local areas and can require wider discussions about individual patients and their associated costs Ensuring appropriate clinical service delivery and process requires access to records

  11. Caldicott2 review and need for interim position • It is agreed by all that there is a need for a holding position • To enable commissioning, PID including NHS no, DOB, Postcode data needs to flow to DMICs • The DMICs need to have similar powers and controls to the HSCIC to process data • In order for processing of PID at DMICs to be undertaken legally, a change in legislation will be required • Legislative changes can not be achieved by April 2013 • Caldicott2 report expected Jan/Feb 2013 • DMICs need to be operational in April 2013

  12. Proposed organisational access to PID for commissioning uses Organisation Require PID flows Exceptions requiring controlled access to PID as per previous slide Justification Facilitates wide use of quality linked de-id data for wider agencies For data linkage & validation for national flows (by small no defined roles) HSCIC Safehaven Facilitates wide use of quality linked de-id data for commissioners DMICx ~9 safe haven For linkage & validation between national and local flows(by small no defined roles) Enables types of Commissioning (as per slide 12) Small number roles which can not be done without use of PID via role based access CSU X~23 Enable aspects of service monitoring Small number roles which can not be done without use of PID via role based access LATS X-27 Access to postcode level data via role based access Access to PID data Enables geographic analysis To monitor at risk populations LAPH X~150 Patient level de-identified data suitable for all aspects of work May require PID if do not use CSU or LAPH CCGs x~212 Enables proactive patient care Clinicians Identifying at risk patients

  13. DMIC interim options • What are the options? • Do nothing - illegal • Send all data flows to HSCIC - impracticable • DMICs part of NCB & apply for section 251 - limiting • DMICs linked with IC + IC special powers – continuity • General agreement that DMICs need PID • NCB will not allow anything illegal • Continuityoption may still need section 251 Personal Observation

  14. How intelligence will be delivered Data Flows To enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets, a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public National Provider (Local flows) National Data Feeds Provider National flows Care.data HSCIC Wider Determinants Audits Safe haven Alternative providers ONS Sub-national Conformed data supplied back up to care.data Local Data Feeds 3rd Sector National/ International Surveys DMICx ~9 Safe haven DMICs may also provide data to wider stakeholders LATs X~27 Local CSU X~23 Small no CCGs doing own intelligence LAPH X~150 CCG CCGs x~210 CCG

  15. DMIC development • DMIC network and technical groups meet monthly • DMIC Network concerned with authorisation • CP2 (Jun 2012) authorised 9 DMICs to proceed • CP5 (Feb 2013) will accredit DMICs as viable • Liaison with industry groups • ISO standards • DMIC technical focusses on service delivery • Interoperability • SUS • Customers • Pseudonymisation

  16. DMIC Technical issues • Access to SUS extracts • DME marts proposed – db 2 db data transfer • IG issues to resolve • Input to DMIC – six data feeds supported SUS inpatients SUS outpatients SUS accident&emergency • Output from DMIC data processing in the form of Logical Data models • 3 logical models submitted to standards (IP, OP, A&E) • 3 more under discussion (GP, Mental health and Community) • 3 more proposed for 2013-14 (111/OOH, Ambulance and Referrals) GP data Community Mental health One possible interoperability set-up • Common Pseudonymisation policy • Re-identification and web service • Common algorithm • Simple implementation in advance of Caldicott2

  17. Data service in 2013-14 • Reality check • Not everything will happen by April 1st 2013 • SUS will not shut down PCT SUS feeds • New organisation hierarchy on some national systems from January • CCG IG function not fully operational • Many CSU BI systems will not be ready by April 1st 2013 • Therefore, • BAU systems will continue to operate through early part of 2013-14 • IG guidance will gradually be applied • The dust will settle as newly authorised organisations take on their statutory duties

  18. Thank you for listeningAny questions?

  19. Hand-out - commissioning activities requiring PID

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