"Quality Issues: Collection, Coding, Metadata - some NHS experiences"

1. "Quality Issues: Collection, Coding, Metadata- some NHS experiences" Philip Johnston NHS Scotland, Information Services Division

2. Quality Issues: Collection, Coding, Metadata- some NHS experiences • about Information Services Division (ISD) • about ISD data • ISD processes, and some examples • some statistics on quality

3. about ISD • part of National Services Scotland, and NHS • 40+ years old • around 650 staff across Scotland • Scotland's national organisation for health information, statistics and IT services • 17 work programmes – eg waiting times, mental health

4. about ISD data • around 60 data sets, evolving • variety of data providers – eg: hospitals, NHS boards, GP practices, voluntary sector, private sector • per year: ~60 publications, ~3000 information requests, ~500 Parliamentary Questions • Part of National Statistics • “Scotland has some of the best health service data in the world”

5. ISD data : some context • some uses: clinical governance, planning, epidemiology, performance management, setting policy • some stakeholders: NHSScotland, Scottish Executive, Scottish Parliament, local authorities, Audit Scotland, GRO, researchers, media, public, political parties • some influences: health policy, devolution, National Statistics, Freedom of Information, data protection, patient involvement, IT developments (eg web), media awareness

6. ISD data : SMR01, an example dataset • patient/episode -based • acute inpatients / day cases • ~100 data items, including clinical codes (ICD, OPCS) • ~1.2m records/year

7. SMR01 data collection • electronic, secure (encrypted) • varying timetables for submission • data for ~1000 locations, from ~17 IT systems • ~100 validation files, with ~3m records • ~1500 error/query checks

8. SMR01 quality : accuracy • Accuracy of coding of main condition, 2000-02, by hospital

9. SMR01 quality : timeliness

10. SMR01 quality : other measures • validity • completeness • fitness for purpose • relevance • coherence • comparability • data ‘sign off’

11. SMR01 quality – some factors • conflicting local/national priorities • IT system issues (eg purpose / specification / delivery) • timeliness vs accuracy • quality of source data (eg case notes) • training and definitions • changes in service delivery

12. SMR01 : example of accuracy versus timeliness

13. SMR01 : some metadata • definition? • Data Dictionary (web-based; ~1500 items), including definitions and recording manuals • statistics on quality of data • data audit controls • Change Control process • ‘health warnings’ on outputs • statistical imputation / suppression

14. other data collection : some examples • census of Allied Health Professionals (non-NHSnet; developmental) • Scottish Birth Record (national repository) • the future, eg: clinical datasets, electronic health record, SNOMED, data warehouses

15. Quality Issues: Collection, Coding, Metadata- some NHS experiences – in summary • range of complex, interdependent factors affect data quality • ISD applies considerable resource to data quality • ISD ability to measure data quality, and to understand influences, is essential and is much valued by users