Somerset PCT PBC Information Project

1. EnclosureB Somerset PCTPBC Information Project Project Update for Local Implementation Team 20th March 2008 Kevin.Hudson@somersetpct.nhs.uk Programme Manager, Somerset RMC 01278 727 401 / 07717 530 220

2. Key Themes • Establish confidence in the data. • Enhance the usability of local PBC information tools. • Explore aspects of PBC information that might not otherwise be developed. • All three aspects of this project are very challenging.

3. Project Structure • Project Governance through monthly Local Implementation Team (LIT). • Monthly Project meeting with UH to work through detailed actions after each LIT. • (At least) Monthly meetings with Wyvern Health to review progress and discuss developments. • Monthly PCT meetings to review Ardentia Issues. • Project Attendance at the Somerset Data Quality Group (YDH/T&S combined Trust meeting) • Monthly Conference Call with Ardentia to progress work on issue resolution and system improvement.

4. 1. Establishing Data Confidence Status and Actions

5. 1: Establishing confidence in data • Original Project Outline identified: • Resolve current data issues. • Agree best source for data (SUS v’s local) • Ensure data completeness (particularly non-Somerset Trusts, primary care services, unscheduled care, A&E). • Ensure data timeliness. • Confirm data cleansing and uplift procedures. • Clear local reconciliation process. • Quality Control Framework: coding audits & close liaison with Trusts. • Mechanism for feedback and adjustment.

6. Data Confidence – UH assistance • Original Project Outline identified: • Independent checking and review of data. • Support for working with SUS. • Recommendations on data cleansing & audit routines. • Advice on incentives and penalties for ensuring accurate coding. • Advice on best practice – national & international.

7. Data Quality: Current Status • Ongoing issues with SUS have delayed Q3 packs. Little PCT confidence in SUS, seems to be shared nationally: e.g • Local Data (T&S) uploaded to SUS, not available to download for a considerable period thereafter (2-3 months delay). • SUS downloads do not match what is uploaded. • Downloads of the same data on the same day gave different results. • Still missing historic Weston data, although current data (December 2007) is uploaded. • A&E data not being fed into Ardentia. • Only mandatory for FTs, but YDH still having difficulty in submitting, and T&S will now also have to send.

8. Data Quality: Current Status (cont) • Growing issues concerning data quality at T&S: • Cerner implementation on 16th December 2007. All patients were discharged on 15th December to be readmitted same day onto new system – has created fictitious extra episodes. • A coding backlog appears to be growing. 1000 uncoded records submitted to SUS to meet to meet the March 2008 freeze date. • T&S have an ambition of real-time coding, but anecdotal feedback from many areas is that Cerner is making existing administration processes take longer, including the coding process. • Current reality is that data quality is perhaps better in the East of the PCT (Yeovil & Bath) than the West (T&S & Weston) 8

9. Data Completeness (SUS): Project Actions • There is a need to identify the best source of information – Local or SUS: • UH to rerun data checks using SUS only. • UH to document issues being experienced in Somerset with SUS:– To advise whether during duration of Project PCT should be working with local data or SUS. • UH to split data quality checks by Trust – identify location of errors. • UH to undertake further data quality analysis as identified in their report to LIT. 9

10. Data Coding Quality – Project Actions • Local Audit Commission Reports on Coding Quality as a starting point for developments on this issue. • Finance Directorate to advise when this report can be published. • Project representation on the monthly Data Quality Group. • PCT raising issues formally with Trusts and Informatics. • UH to advise on best practices for quality control framework, penalties & incentives. • Project team to map all Coding Activity in Somerset and the framework of how these staff are supported. • Investigate / Pilot use of IQ Budget Manager as a tool for Practices to validate HRG Codes

11. IQ Budget Manager • Tool that can work with Ardentia to reconcile PBC data. • Links to Exeter system to automatically identify patients who are not registered at that Practice. • Can identify patients where the HRG does not seem to match the condition of the patient. • Produces an exception report for further investigation. • Potentially expensive for Somerset as a whole: 25p per registered patient per year. • May be cost-effective in “lighthouse Practices” conducting sample audits on behalf of the whole community.

12. 2. Enhancing Usability - Status and Actions - Training and User Support

13. 2: Enhancing usability of information • Original Project Outline identified: • Decide on how information will be presented: Ardentia, Ardentia “bolt on”, completely new system. • Mechanism for user feedback and development. • Identify information priorities of key stakeholders. • Establish mechanisms for benchmarking. • Develop “presentational front end”. • Plan Ardentia development time • Link with other Ardentia users. • Regular cycle of distribution packs. • Redesign and improve presentation of packs.

14. Support from Ardentia • 27th February – User Open Day: Opportunity for all Ardentia Users to go to Ardentia HQ in Stafford & discuss issues: • Only 3 Attendees (of 91 user organisations) – Somerset, Dudley & Thames Valley. • Issues with SUS & Flex/Freeze dates appeared a common theme. • A useful day for understanding the product, learnt some new methods (e.g. for interrogating usage of system). • Then found what worked in Stafford didn’t in Somerset – hence on the Somerset Ardentia issues log. • However, Monthly Conference calls with Ardentia are proving useful, and locally raised issues are being resolved.

15. Usability – Practice Observations • Information needs to be presented to Practices in usable formal. Neither Ardentia nor Quarterly Packs do this. • Information navigation needs to be straightforward. • Current Information Overload – Spreadsheet too large and unwieldy for Practices / Impractical to Print. • Information ideally needs to be monthly. • We need to understand who is using Ardentia – enable this functionality on Ardentia as a matter of priority.

16. Usability – Improvement Proposal • Process is essentially episodic. Lends itself to navigational slides rather than real time interrogation: Therefore: • Summarise Practice performance in a Dashboard report. • Have supporting detailed information behind each Dashboard Headline (Specialty, Provider, Trend, Comparison). • Tailored Printed copy for each Practice: Dashboard and the details where the Practice is at negative variance. • On Line Version of the Reports: Navigable slides on line with a intelligent link into Ardentia if patient level detail is required. • Need to work of the design of information with pilot practices.

17. Structure of On-Line Practice Info

18. Practice Dashboard – mock up

19. Practice Dashboard - links 19

20. Practice Dashboard – mock up #2

21. Breakout for Navigable on-line information using Adobe Flex Demonstration

22. Next steps for Improving Usability • Agree approach & content of Dashboard (PCT / LIT / WyH). • Identify Pilot Practices (LIT / WyH). • Build demo for Pilot Practices based on Q3 packs (PCT) • Design Dashboard and Supporting Spreadsheets (Information Team) • Build Web Based navigation system (RMC) • Construct automated print macros for tailored reports (RMC) • Launch a full PCT wide system based on Q4 packs (PCT) • Beyond Q4: Improve & refine presentation / work towards monthly updates of information.

23. Training and Practice Support • The Choose and Book GP Support line has received over 2000 calls since April 2007 • This indicates the level of support required for an IT system that is actively used. Therefore... • Extend CAB Support Line to cover Ardentia Queries. (CAB support staff are being trained in Ardentia during March). • Incorporate Ardentia within the formal IT training structure for Practices (Discussions are ongoing with Informatics). • Aim to communicate to Practices re: new structure of Training & Practice Support in Early April.

24. Do we have all the tools? • We seem to only have the basic PBR/PBC Ardentia System. There are a number of additional modules available including: • Population Extension – monitors and compares demographics. • Outpatient / Inpatient / A&E modules – all attendances (not just PBR) • Commissioning Extension – for contract & SLA monitoring. • Net Transform – alternative mechanism of upload to SUS. • PCT is researching whether it has a need for these modules. • Also IQ Project Manager has been identified as a potential tool for Practices to validate information reported from Trusts (particularly whether the correct HRG has been used).

25. Emergency Information • Daily information now being submitted to RMC. • RMC will look to build an information system that: • Automatically provides Practices with this information on the frequency they have requested (daily / weekly / monthly). • Presents information in a enhanced usable format. • Adds additional information (e.g. Number of previous admissions). • Target information system completed by end April. • Ultimately link with other information sources • Daily discharge information. • E.g: Somerset Primary Link and Choose and Book.

26. 3. Exploring new areas of Information - Status and Actions

27. 3) Exploring new information areas • Original Project Scope identified: • Set objectives – further discussion at LIT & with stakeholders. • RISC: Demonstration and pilot by UH. • Alternative ways of identifying health needs of local community. (e.g. Actuarial data). • Reporting systems for unscheduled care & Somerset Primary Link. • Complete work on unscheduled admissions and consultant to consultant referrals. • Reporting system for PBC primary care iniatives.

28. New information – UH assistance • Original Project Outline proposed: • Develop linked project plan to examine methods of identifying health needs of patients. • Support PBC information needs in relation to public health, unscheduled care & long term conditions. • Identification of tools to best identify health needs. • Support on exploring use of actuarial information. • Advice on best practice – national and international.

29. “Identifying Future Health Needs” • Meeting on 3rd April with PCT, WyH, UHUK and pilot practices to map the information framework for “Identifying the Health Requirements of a Practice’s Patients”. • Ensure work by Public Health Directorate (Cam Lughton) is incorporated within the project / no duplications of effort. • Once framework is identified, then calculate real numbers in pilot Practices. • Also at this stage identify the “measurement tool” for these pilot Practices (Parr+ / RISC)

30. Possible Framework to Discuss • WyH have identified the following Framework: • The Information Project will need to calculate the numbers in these boxes for real Practices.

31. In Summary • Work on improving data quality is ongoing, but this will be a long process. • IQ Budget Manager may help – investigate a pilot. • Proposals for enhanced usability need to be improved – start work on Q3 demos with Pilot Practices. • GP Practice Ardentia Support Line from 1st April. New Training approach to be confirmed. • Agree framework of identifying future health needs on 3rd April. Work with Pilot Practices to calculate “numbers” thereafter.