DSfC - Thurrock Council SUS/MH Application - Comm

To use pseudonymised data to provide intelligence to support commissioning of health and social care services. The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the Local Authority area based on the full analysis of multiple pseudonymised datasets.

The Local Authority commissions services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

o Secondary Uses Service (SUS)

o Mental Health Minimum Data Set (MHMDS)

o Mental Health Services Data Set (MHSDS)

o Improving Access to Psychological Therapy (IAPT)

The pseudonymised data is required to for the following purposes:

 Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

• Using value as the redesign principle

• Ensuring we do what we should

 Data Quality and Validation – allowing data quality checks on the submitted data

 Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

 Understanding cohorts of residents who are at risk of becoming users of some of the more expensive services, to better understand and manage those needs

 Monitoring population health and care interactions to understand where people may slip through the net, or where services/interactions may be being duplicated

 Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another

 Service redesign

 Health Needs Assessment – identification of underlying disease prevalence within the local population

 Patient stratification and predictive modelling - to identify specific patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

“General Commissioning” means the use of de-identified linked data, for the following purposes:

 Contract Management and Modelling

Processing for commissioning will be conducted by MedeAnalytics International Limited ("MedeAnalytics").

National identifiers will be removed by NHS Digital (DSCRO) using MedeAnalytics’ Pseudonymisation at Source process, prior to data leaving NHS Digital. By using the MedeAnalytics process, the resulting de-identified data can be linked within the MedeAnalytics system with data from other providers (as specified in this application) using the same process, without the need for identifiable data to flow to MedeAnalytics at all. Further, as national identifiers are removed by NHS Digital before transmission, thus rendering the data Anonymous in line with the ICO’s anonymisation code of practice, the resulting, non-identifiable data representing 100% of the commissioner’s records is suitable for General Commissioning and Contract Validation purposes, both of which have been previously approved.

Where analysis of pseudonymised patient records show that the associated patients could benefit from clinical interventions, GP Practice users who have legitimate relationships with the patients will be able to re-identify the patient records so that they can provide the interventions (direct care).

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement. The data to be released from NHS Digital will not be national data.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

Onward Sharing

Patient level data will not be shared outside of Thurrock Council unless it is for the purpose of Direct Care, where it may be shared only with those health professionals who have a legitimate relationship with the patient and a legitimate reason to access the data.

Aggregated reports only with small number suppression can be shared externally as set out within NHS Digital guidance applicable to each data set.

Segregation

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

Data Minimisation

Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:

• Patients who are normally registered and/or resident within the Thurrock Council (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where Thurrock Council is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of Thurrock Council - this is only for commissioning and relates to both national and local flows.

Commissioning

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:

1) SUS

2) Mental Health Minimum Data Set (MHMDS)

3) Mental Health Services Data Set (MHSDS)

5) Improving Access to Psychological Therapy (IAPT)

Data quality management and pseudonymisation is completed within the DSCRO using the MedeAnalytics pseudonymisation tool and is then disseminated as follows:

1) Pseudonymised SUS, Mental Health data (MHSDS, MHMDS ), and Improving Access to Psychological Therapies data (IAPT) is securely transferred from the DSCRO to the Local Authoritys’ data processor, MedeAnalytics International Limited where it is received, stored and processed

3) Records contain no national identifiers, but do contain the following local identifiers: [Local Patient Identifier], [Hospital Provider Spell No], [Unique CDS Identifier], [Attendance Identifier], and [A&E Attendance Number]

4) On arrival at MedeAnalytics International Limited, one of the MedeAnalytics International Limited operational staff then transfers the data from the secure landing zone to the ETL process. The Extract Transform Load (ETL) process then loads the data into the MedeAnalytics International Limited system, where it is linked.

5) Allowed linkage is between the data sets contained within point 1 and the following data that is pseudonymised at source using the MedeAnalytics pseudonymisation tool:

o Social Care data

o GP Practice data

o Community data

o Care Home data

o Planning data

o Continuing Healthcare (CHC) data

o CAMHS data

o Hospice data

6) Access is fully controlled by Role Based Access Control (RBAC), signed off by Caldicott Guardians/SIROs.

7) Local Authorities use the workflow features provided by the MedeAnalytics International Limited Contract Validation Module to check recorded activity against contracts, and facilitate contract discussions with providers

8) Local Authority users use online features of the MedeAnalytics International Limited system to produce reports, charts and dashboards to analyse the data for the purposes listed.

9) Pseudonymised patient level data will not be shared outside of the Local Authority and will only be shared within the Local Authority on a need to know basis with access fully controlled by RBAC, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared.

Segregation

Data is held within the MedeAnalytics system, and is segregated according to contract.

Only MedeAnalytics operational staff (individuals operating under full time MedeAnalytics employment contracts) have access to data prior to loading into the main system.

All staff at MedeAnalytics undertake compulsory IG Toolkit training every year.

All MedeAnalytics staff understand their responsibilities with regard to receiving, storage, processing and handling of data, and contractual sanctions that can result in disciplinary actions including dismissal for contraventions are included in employee contracts.

Specific processes are in place to setup new system users, all of which require Caldicott Guardian or SIRO sign-off in order to obtain user identities and passwords. Identities and passwords are restricted to specific subsets of data according to their Roles, so that a Local Authority user can only see data for their own Local Authority, and a GP user can only see data for their own GP Practice.

All access to data is managed under Roles-Based Access Controls

Access to data is provided through the MedeAnalytics front end interfaces, for on-line access; while it is reasonable and allowable for users to export the results displayed in reports, charts and dashboards, so that the results can be used in board presentations, reports and other management documents, bulk export of underlying linked data sets is not possible.

All accesses are audited

Only appropriate staff involved in population health management will access the patient level data.

Local Authority staff are only able to access data pertinent to their own Local Authority

GP Practice staff are only able to access data for patients registered to their own practice

Re-identification (managed under RBAC) requires an additional step to access re-identification keys held by an independent third party key management service (operated by BMS) that has no access to the data. Disabling a user’s account in the key management system immediately removes the ability of that user to access re-identification keys.

Each Re-identification requires a different key, so inappropriate retention of keys (which is neither allowed, nor easy to accomplish by design) will not result in compromise of data

Only GP Practice users are able to re-identify patients and only when they have a legitimate reason and a legal right to re-identify have access to encrypted data, and can only access data to which they have rights under RBAC (which is CG/SIRO approved – within the Local Authority)

All data providers for a particular region (according to contract) are issued with encryption keys that ensure data for their region can only be linked to data from other providers for the same region. This means that data for two different regional customers cannot be accidentally mixed.

Continuing Health Care data will be securely retained separately from the pseudonymised linked outputs received by the Local Authority from MedeAnalytics.

The MedeAnalytics tool is used inside organisations for pseudonymisation at source so this work is not undertaken by MedeAnalytics.

MedeAnalytics will not link this data with any other data, apart from the linkages described in the agreement.

Commissioning

General reporting

1. Commissioner reporting:

a. Summary by provider view - plan & actuals year to date (YTD).

b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.

c. Summary by provider view - activity & finance variance by POD.

d. Planned care by provider view - activity & finance plan & actuals YTD.

e. Planned care by POD view - activity plan & actuals YTD.

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

5. Monitoring of acute / community / mental health quality matrix.

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports

Analytics Insights

Reports, charts and dashboards providing insights into:

1. Comparators of CCG/LA performance with similar areas as set out by a specific range of care quality and performance measures detailed activity and cost reports

2. Data Quality and Validation measures allowing data quality checks on the submitted data

3. Contract Management and Modelling

4. Patient Stratification, such as:

o Patients at highest risk of admission

o High cost activity uses (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

5. Understanding impacts and interdependency of care services

Commissioning

1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.

3. Health economic modelling using:

a. Analysis on provider performance against 18 weeks wait targets.

b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.

c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.

d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).

4. Commissioning cycle support for grouping and re-costing previous activity.

5. Enables monitoring of:

a. Local Authority outcome indicators.

b. Non-financial validation of activity.

c. Successful delivery of integrated care within the Local Authority.

d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.

8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.

10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the Local Authority Outcome Framework.

11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.

12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts

13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

All of the above lead to improved patient experience through more effective commissioning of services.

The introduction of integrated hubs is still underway, but the selection of pilot sites was informed by these analyses, MedeAnalytics will be used to evaluate the ongoing benefits of the hubs. Users fed back that:

Showing the number of benchmarked A&E admissions (and A&E attendances in the next analysis) from specific local geographical locations in a heat map, will enable the Local Authority and providers to direct our finite health and social care (public health) resources more efficiently and effectively.

Users can better understand variation in their system, and make comparisons between populations and organisations in a fair and meaningful way with a greater understanding of what normal is. This will support routine opportunity analyses that they carry out in order to best target resources and best understand which activities have had a genuine benefit, and helped reduce costs to the system.

In addition, the platform provides access to comprehensive supporting information that commissioning organisations such as Clinical Commissioning Groups use to ensure that the services they commission:

• deliver the best outcomes for their patients

• cater for and meet the needs of the population they are responsible for;

• monitor condition prevalence within the population

• identify health inequalities and work with local organisations and agencies to remove them

Also for Acute Trusts and other care providers it provides access to comprehensive supporting information that helps to:

• ensure that the services they provide are of high quality, efficient and effective;

• plan and re-engineer services to meet the changing requirements and developments in technology;

Direct measurement of the benefits associated with an enabling self-service system such as this is challenging, however, proxies can be provided through use metrics (number of individual users and frequency of use) as well as examples of decisions made by customers in the management and delivery of their services that have been supported by reports / information from the Mede tool

Thurrock Council to date only linked the data to Adult Social Care Data. Thurrock Council have begun to do some population segmentation work looking at characteristics of cohorts who are high spend across both services. The benefits continue from the council's use of SUS data in a linked data system called (MEDE).

Thurrock Council have used SUS data to complete the first phase of an evaluation into an alternative approach to providing Adult Social Care. The evaluation has already allowed the council to identify potential for significant cost savings across the local health system through reduced unplanned admissions and fewer bed days. Thurrock Council are also using SUS data to understand the scale of the COVID-19 pandemic locally, informing local strategic decision making around resource allocation and designing patient pathways for specific conditions.