Hampshire Clinical Repository Hugh Sanderson Head of Clinical Information Development

1. Hampshire Clinical Repository Hugh Sanderson Head 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”

2. Overview • What is it • What does it look like • Clinical feeds/ Date entry • Security and consent • Database • Potential 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”

3. What is it? 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 “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”

4. 200+ GP practices Data entry screens Exeter Winchester Portsmouth Southampton North Hants d e s s i Anonymised i s m y l y Trusts a s n n d database o e A n e A PAS, Pharmacy, Clinical Access f e m Pathology, CDR i t Radiology, Cancer Databases, Clinical letters l a e Patient Index R / y l Clinical Record i a D “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”

5. Why are we doing it? • 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 “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”

6. Benefits • 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. “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”

7. “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”

8. “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”

9. “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”

10. “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”

11. “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”

12. Direct data entry • Single assessment process • Occupational Therapy • Cancer MDT records • Can be partially completed and updated later • Drop down menus and date selection “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”

13. “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”

14. 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”

15. InformationGovernance Clinical Repository Advisory Group • GPs • Acute Hospital / Primary Care Trusts • Mental Health Trust • Patients/ Carers • LMC Advise on security arrangements and data analysis requests and information to the community. “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”

16. Consentmodel • 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 “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”

17. Data Analysis • Samples from the Central Hampshire pilot • Early results of analysis from Hampshire “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”

18. Post operative wound infections • 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”

19. 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 Chronic diseaseMonitoring “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”

20. “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”

21. “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”

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

23. Value for clinical Indicators • 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. “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”

24. Ongoing Issues • Coverage of all practices/ trusts/ independent providers. • Data quality ( especially GP records) • Comparability of lab results. • Security, confidentiality and Information governance. • Distributed analysis service “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”