and Information Quality

1. and Information Quality Information Governance Data Quality Team

2. Objectives By the end of this session you should be able to: • Understand why good quality data is vital • Know what good data quality supports • Understand current initiatives driving data quality • Understand the role of data quality in Information Governance • Understand your responsibilities for data quality and appreciate it’s importance within your role • Minimise risks arising from poor data quality

3. Data and Information Defined Data Facts, readings, measurements – items that are essentially ‘value free’. Data means information which: • Is being processed by means of equipment operating automatically in response to instructions given for that purpose • Is recorded with the intention that it should be processed by means of such equipment • Is recorded as part of a relevant filing system or with the intention that it should form part of a relevant filing system, or • Does not fall within the above but forms part of an accessible record as defined by section 68 of the Data Protection Act 1998. e.g. health record

4. Data and Information Defined • Information • Data that has been interpreted or to which commentary has been added by a user for a purpose making it ‘value-laden’ • Quality • Has two aspects: • i. The characteristics that meet user needs and thereby provide user satisfaction • ii. The absence of deficiencies that result in user dissatisfaction

5. Introduction • This session has been designed to provide you with an insight in to data quality and to enhance your understanding why high quality data is vital to the NHS • The importance of data quality is ever increasing within the NHS in order to meet the demands of legislation, standards of practice and to support clinical care of our patients • It is important to remember that data quality relates to all data within the NHS, both clinical and non-clinical, and supports so much of what we do • All healthcare is information driven, so the threat associated with poor data is a direct risk to the quality of healthcare service and governance in the NHS

6. All information in the NHS is built up from facts and figures from a variety of sources. These ‘data’ form the basis of whatever information is used in the NHS • The data is used locally, but also nationally, to inform, plan, performance manage and contribute to national statistics • To ensure consistency and comparability at a national level there are numerous rules and protocols about how, when and why certain data should be collected • In practice, most data in the NHS is gathered as part of the everyday activity of thousands of frontline and support staff working in a huge variety of settings • NHS Trusts with poor data quality or poor use of information are unlikely to be in a position to provide services efficiently, effectively and economically

7. Why does the quality of data matter? • High quality information is vital for safe and effective patient care and for this purpose 100% accuracy 100% of the time must be the main objective • Data and information is increasingly being used in new and different ways in a range of different settings, underpinning the continuity and quality of care • High quality data underpins sound decision making at every level in the NHS • Poor quality data impacts directly upon each and every use made of that data • Assists in clinical and other types of audits

8. High quality clinical and non-clinical data and information means improved patient care and patient safety. Clinicians have greater levels of confidence when advising patients on the basis of accurate , up to date, complete data • High quality data and information on demand will give staff more time to treat and advise patients and make other important organisational decisions. Less time will be spent searching, waiting, checking or validating information • Accurate data and information supports correct payments under the Payment by Results framework and ensure Trust’s can maintain and improve services • Meet legal requirements, including requests for personal information under section 7 of the Data Protection Act 1998 • Meet legal requirements, including requests for information under the Freedom of Information Act 2000

9. What should you have an understanding about? • What data you are recording and how it should be recorded • Why you are recording the data • How to validate data to ensure it is correct at the point of recording • How to identify and correct inaccuracies or discrepancies i.e. make yourself aware how to correct inaccuracies or how to report them once identified • How the data will be used therefore why timeliness, accuracy and completeness is vital • How to update data fields and add in further data from other sources

10. Characteristics of Good Data Quality There are 6 key characteristics of good data quality: Validity • All data items must be valid • Where codes are used they must conform to national standards • Majority of codes are in the background of PCIS pathways e.g. GP practice codes, Ethnicity Completeness • All mandatory data items should be completed • Use of default codes should only be used where appropriate and not as a substitute for real data • If it is necessary to bypass a data item then the missing data should be reported for immediate follow up and input correctly e.g. admission / discharge dates and times, GP prior to discharge etc

11. Consistency • Data items should be internally consistent • Structured PCIS pathways ensure consistency for certain fields • Free text fields must follow correct formats e.g. names, addresses • Ensure you are aware of which rules apply regarding data fields Coverage • Data must reflect all work done by the Trust i.e. admissions, outpatient attendances, operations and procedures • The same applies to other business functions e.g. finance, human resources • This is reflective of electronic and manual recording systems e.g. physical health record

12. Accuracy • Personal data shall be accurate, and where necessary, kept up to date (Principle 4, Data Protection Act 1998) • Data are inaccurate if they are incorrect or misleading as to any matter of fact • You should take reasonable steps to ensure accuracy of data. These checks should occur: • Whenever a patient attends an outpatient appointment • Whenever patients present at Accident and Emergency • Whenever a patient contacts the Wirral Hospital Booking Service • On admission • Whenever referrals are received via GP letters as GP’s may be the first to know about changes of address etc • Always confirm all details during contact with patients • Utilise validation methods e.g. Open Exeter, Summary Care Record, Postcode Checker etc Accurate Input = Accurate Output

13. Timeliness • All entries and recording of data should be made contemporaneously to ensure availability of the data at any given time • Recording of timely data is beneficial to the patient journey and will allow decisions to be made sooner rather than later • Data should be entered ‘real time’ or as close as possible after the event • Data should not be saved up to be entered at a later stage e.g. entering multiple patient discharges at the end of a shift • If data does need to be entered retrospectively then it is imperative that the correct data is entered • Ensure you backdate dates and times correctly and replicate everything from the paper health record for consistency

14. Drivers to achieve high quality data • NHS Plan • Payment by Results (PbR) • National Service Frameworks (NSF’s) • National Programme for Information Technology (NPfIT) • Information Quality Assurance Programme • Kennedy Report • Data Remember Management Paper from the Audit Commission • Pressure from clinical communities • Increased risk that clinical care will be undermined • Clinical Audit and Governance • Statistical Analysis

15. Payment by Results (PbR) • The NHS Plan (July 2000) introduced the Government’s intention to link the allocation of funds to hospitals to the activity they undertake • Historically, hospitals were paid according to “block contracts” – a fixed sum of money for a broadly specified service • It rewards efficiency, supports patient choice and diversity and encourages activity for sustainable waiting time reductions • Payment is linked to activity and adjusted for casemix • Lengths of Stay (correct admission and discharge dates / times) • Types of attendance (emergency, electives, outpatient) • Everything that happens to a patient has a tariff applied • For further information on Clinical Coding e.g. HRG’s, contact Clinical Coding Manager x2610 • The data you input has potential financial implications for the Trust

16. Benefits to the Trust • The Trust will be regarded as a trusted provider of data among information sharing partners • The Trust will receive correct payment via the PbR framework and ensure it can maintain and improve services • The Trust will be compliant with it’s professional and legal obligations • The Trust will provide a secure and trusted environment for the management of data • Demonstration of the application of best practice in data quality • The Trust has a strengthened position in the event of any challenge (including legal) against the organisation • Migration of complete and accurate data to Cerner Millennium • Reduction in duplication of effort therefore efficient use of resources

17. Audit Trails and Incident Reporting • PCIS captures an audit trail of all data entered at individual user level • Data inaccuracies are identified via automated reports (EDR) and issues identified by members of staff • Issues are reported formally at regular intervals to Divisional Managers to address with individual staff members • Divisional / Directorate performance is monitored and issues raised at senior management meetings • Report any information related incidents via the Trust incident reporting procedures. The Trust promotes a no blame culture. • Report missing, incomplete or poor data entry for investigation (it could be personal data relating to you one day which impairs decision making and potentially your healthcare)

18. What is the importance of PCIS data you record? Postcode of Residence • If the Postcode is incorrect or missing, this may mean that important clinical letters may be delayed or misdirected. It will also affect epidemiology and allocation of resources Ethnic Category • Required for service planning and studies of health inequalities Registered GP (Code of Practice) • Ensures that communication is sent to the correct GP Practice either by post or via the EHR. This is important for PbR, as patients are now registered with GP Practices rather than GP Practitioners, and some health care professionals in GP Practices are engaging in commissioning activity for their patients.

19. Date of Birth • Used in calculating age-related indicators. Also used in the tracing and verification of the NHS Number Sex • Used for epidemiology, and also used in the tracing and verification of NHS Number Admission / Start Date • A key date for the calculation of waiting times and to mark the start of the hospital provider spell, and hence, payments under PbR (checked for all episodes in spell) Admission Method • Affects resource planning and the correct allocation of episode to the commissioner (checked for all episodes in spell)

20. Source of Admission • Needed for service and healthcare planning (checked for all episodes in spell) Discharge Destination • Needed for service and healthcare planning and for liaison with other care organisations Discharge Method • Provides an indication of the outcome of care and is used for epidemiology Discharge Date • Important for the calculation of hospital spell, and hence, payments under PbR, and for delayed discharges

21. Decided to Admit Date • Used in calculation of waiting times (elective patients only) Referring GP (Referrer Code) • Code of the person making the referral. This will reflect the actual referrer, for example: a consultant may refer a patient to another consultant within the same hospital provider spell. This field is important for PbR. NHS Number • If incorrect, activity may be assigned to the wrong health record Attend or Did Not Attend Status • Used to identify DNA rates in order to take steps to reduce non-attendances

22. Your Responsibilities • Conduct thorough searches on PCIS as per the data quality guidelines and input ‘quality’ data • Approach your line manager if you feel you require further training or support within your role e.g. PCIS – don’t be afraid to ask • Be responsible and accountable within your role • Report data related incidents promptly • Remember that data quality applies to everything that you record both on electronic and manual systems • Keep up to date with NHS agendas and the importance of data quality • Follow Trust policies, procedures and good practice guidelines – they exist for a reason • Follow up missing data and make every effort to try and locate it

23. Problems and Help • Contact the Data Quality Team ext. 8168 if you are unable to locate patient demographic data or if you have issues relating to: • Admission and discharge details • Duplicate patient records • Unable to locate a patients GP • Incorrect Patient Admitted or discharged on PCIS • Duplicate or incorrect episodes • Patient under wrong specialty or consultant • Incorrect patient record used • Ensure this is done prior to discharge to ensure it does not hinder the continuing patient journey or pose a clinical risk Questions?