NHS Digital in partnership with techUK

1. NHS Digital in partnership with techUK Friday 21 September 2018 10am – 1pm SNOMED • Wi-Fi network: techUK Password: STB9897321

2. WelcomeBen Moody Head of Health and Social Care techUK

3. Agenda

4. Purpose of the DayIan Binns Head of Information Analysis (Community and Mental Health)NHS Digital

5. NHS Informatics Strategy • SNOMED CT is a national standard under the Health and Social Care Act 2012 • In 2014 National Information Board (NIB) published Personalised Health and Care 2020: • endorsed the retirement of Read/CTV3 (completed April 2018) • required implementation of SNOMED across the NHS … • By April 2018: • systems used by GP service providers must adopt SNOMED CT • By April 2020: • Secondary Care • Acute Care • Mental Health • Community systems • Dentistry • And … other systems used in the direct management of care • Social Care is in scope of the standard but there are currently no required implementation dates

6. Mental Health information • Mental Health is a key priority (as emphasised by numerous policy documents) • Information is required to: • understand the current situation • monitor improvements • We already collect lots of mental health data: • via the Mental Health Dataset • via UNIFY – some of which is also collected by the Mental Health Dataset • no body wants providers to submit data twice! • The world keeps changing … • the Mental Health Dataset is updated every year (which helps) • SNOMED is updated every 6 months (which helps even more) • Reducing the burden … • improved SNOMED coverage will allow us to retire the duplicate collections • reduce the chance of asking for additional ‘interim’ collections

7. Mental Health Outcomes and Improvements • The Improving Access to Psychological Therapies (IAPT) Data Set collects treatment and outcomes data. • This has been used very effectively to improve IAPT services. • SNOMED provides a more structured way of collecting outcomes and treatment data. • It could be used further to improve Mental Health services and outcomes. • Funding has been requested from DH to support a SNOMED Improvement Programme. • please tell us how we could help you to further improve SNOMED coverage.

8. Data Services Programme (DSP) • NHS Digital is implementing the Data Services Programme. • Hardware and Infrastructure used at NHS Digital to collect and analyse mental health data will change for MHSDS v4.0 (from April 2019). • This will support our move to FASTER DATA. • And will require all providers to update how they submit to MHSDS.

9. Aim of today: • Listen and understand: • Challenges to the adoption of SNOMED CT • What support do you think is required • NHS Digital and NHS England will take your comments on board for next steps

10. OverviewDenise DownsTerminology SME, NHS Digital Matt Matt Wickenden and Clare PerryMental Health Team, NHS England

11. What is SNOMED CT? • A national common vocabulary of ‘Clinical phrases’ for electronic systems • Has content for all clinical professions and specialties to enable electronic exchange of data and decision support • For recording information in relation to the direct care of the patient • Is different to a classification (e.g. ICD-10) • Examples: • Asthma • Headache • Open heart surgery • Referral to paediatrician • Ideal body weight • Serum glucose level • No family history of diabetes • No history of migraine

12. Why? • Main reasons: • Reduce burden • Improve patient care • Provides a more complete patient record.

13. Benefits

14. What does ‘do SNOMED’ mean? • Key data items can be sent/received/recorded using terms from SNOMED CT: • Diagnosis/symptoms • Procedures • Allergies • Medicines • Clinical data requested for datasets or in relation to national guidelines and processes in SNOMED CT e.g. • Assessment scales • Reason for referral • Family history • Observables/test results • Current problems

15. SNOMED CTMental Health Matt Wickenden and Clare Perry england.mhinfrastructure@nhs.net 21 September 2018

16. Supporting the FYFV commitments • NHS England has outlined a clear commitment to driving a more equal response across mental and physical health. A key element of this is ensuring that people have timely access to evidence-based and effective treatment • The intention of mental health access and waiting time standards is to provide timely access to evidence-based care for those in need • The Mental Health Services Data Set (MHSDS) captures intervention and questionnaires using SNOMED codes. FYFV commitments related to NICE recommended treatment are reliant on SNOMED codes. Not all local IT systems currently capture or map these codes • The expectation is that all areas will have implemented this methodology by 2020

17. Reducing burden • Data quality (incl. coverage) issues undermine validity and utility of mental health data & delivery of FYFV • Until NICE concordance can be measured via recording interventions (using SNOMED codes) in the MHSDS, NHS England is required to commission bespoke data collections to measure quality of care • Bespoke collections put burden on the system and lead to duplication • National clinical audits starting to use existing data sets to assess team performance (via SNOMED codes) • ‘Moving towards a world without case notes’

18. Outcomes Recording of outcomes is standard practice in physical health conditions and therefore, for parity of esteem, the same would be expected for mental health. Reporting of outcome measures through the MHSDS • Demonstrates the extent to which mental health services are helping people • National and international benchmarking of services • Drives service improvement The following are examples of policy specific requirements of SNOMED codes in relation to outcomes: • The Access and Waiting time standard for Early Intervention Psychosis services recommended the use of three outcome measures, HoNOS, DIALOG and QPR, and these should be collected at least twice in a referral in order for services to meet the standard. • A national outcome metric for children and young people’s mental health has been developed • ‘reliable improvement in symptoms and functioning’ • In 2018/19 data is being fed back to providers to drive improvement with support to understand differences between local and national reporting.

19. Closed referrals in 2017/18

20. Current published guidance Guidance for Reporting Against Access and Waiting Time Standards: CYP ED & EIP and FAQs document Early Intervention in Psychosis – Recording and Reporting Eating Disorder for CYP – Full Implementation Appendices Dementia Care Pathway Appendices and Helpful Resources Urgent and emergency mental health care pathways (Guidance for improving data quality in the MHSDS) Perinatal MH Care Pathways Appendices and Helpful Resources

21. Contact details For general SNOMED and MHSDS enquiries please email england.mhinfrastructure@nhs.net For CYP providers looking to access their outcomes data please email sally.milne@nhs.net with the subject line ‘CYP MH Outcomes network’

22. Questions and AnswersBen Moody Head of Health and Social Care techUK

23. Workshop 1 What are the challenges you face to enable you to comply in providing SNOMED CT?

24. Lessons Learnt: General PracticeMHSDSA trust: NELFT

25. Ask for General Practice systems: • Users can record SNOMED CT terms e.g. to meet guidance • Send and receive SNOMED CT terms in messages e.g. an electronic Discharge • Process specifications in SNOMED CT e.g. for national commissioning • Systems have provided a browser to enable selection of terms for data entry, writing searches, templates, calculators etc. Record Send / Receive Process

26. Requiring the change • GPSoC holds the contract with suppliers, required the change following the ISN • GPSoC provided:

27. A transition

28. Maintain continuity • Historical data mapped to SNOMED CT to enable searches and graphing over historical data • Time period when data ‘held’ in both old and new codes – either within the record or within a look-up table Dual Coding Read Codes Mapping SNOMED CT Codes

29. User impact • End users: minimal impact • Users on pilots found SNOMED intuitive • Search/template developers: training via webex, users found SNOMED CT logical • Those webinars are recorded and available now (Web search: Delen primary)

30. Housekeeping • Thousands of existing reports and templates • BUT not been reviewed in years! • Data Quality Considerations

31. Lessons Learnt: MHSDS

32. Data received • Feels like allocating a classification rather than coding for patient care • Some codes are outside what would have been defined in data dictionary codes • Will allow to reflect current practice rather than lag change ECDS: £1 to a 1p

33. SNOMED NELFT Approach Tricia Aveling Clinical Lead for Mental Health Outcomes

34. Use existing record keeping processes wherever possible • Use clinical language in the record, SNOMED in the background • Have a Trust agreed list of SNOMED codes assigned to picklist options, use mandated codes where available • Set key items as mandatory in the electronic patient record (EPR) where possible • Put SNOMED codes on the EPR set up where possible

35. Clinical View of Appointment Activities System View of Appointment Activities

36. Link forms to appointments for MHSDS

37. Summary • Make the process as meaningful and simple as possible for clinicians • Ensure close working between services, reporting teams and record system teams • Identify someone to take a lead on developing a draft mapping • Put procedure in place for new items to get initial coding and updating existing coding and mapping

38. Workshop 2 What support is required over the next 18 months? What messages would get buy in / get attention to instigate change?

39. Questions and AnswersBen Moody Head of Health and Social Care techUK

40. Terminology helpdesk: Information.standards@nhs.net