Diagnostic Imaging Data

The Diagnostic Imaging Data set was originally owned by NHS England and transferred to NHS Digital in 2016. NHS England were using this data prior to this date and they hold data from 2012 onwards.

The primary purpose of the flow is for production of Official Statistics, answering Parliamentary Questions (PQs) and media queries, which are the current responsibility of NHS England as subject matter experts.

In addition, NHS England will use the data for jointly assessing and addressing data quality problems with NHS Digital.

Access to pseudonymised record level Diagnostic Imaging Data will also enable NHS England:

• To perform better analysis of cancer pathways by indicating where, what and when imaging takes place in the pathway

• To allow Public Health England to calculate more accurate estimates of the distribution of individual radiation dose estimates from medical exposures

• To enable analysis of demographic and geographic variation in access to diagnostic imaging tests

• To provide detailed national data on trends and patterns in NHS imaging to demonstrate how expensive equipment and trained workforce are deployed and support capacity planning

• To discontinue the existing annual KH12 data set and reduce burden on providers

• To understand and influence issues around delays in access and turnaround times for tests (including analysis of median periods and distributions)

• To provide more detailed national data than is otherwise available on test type (modality), body site of test and patient demographics, which can reveal the impact of initiatives to improve outcomes for patients by influencing the type, timing and number of tests

• To allow benchmarking in the rate of provision of diagnostic tests overall and in GPs’ direct access to tests, to encourage increased use of tests leading to earlier diagnosis and hence improved outcomes

• To inform accreditation processes for imaging departments through the UK Imaging Services Accreditation Scheme and the assessment of imaging services by the Care Quality Commission.

• To inform work on development of accurate tariffs for all diagnostic imaging tests

NHS England currently hold pseudonymised Diagnostic Imaging Data from April 2012 onward. The Diagnostic Imaging Data received within this agreement will be added to the Diagnostic Imaging Data already held by NHS England which is used to create monthly and annual Official Statistics publications.

Diagnostic Imaging Data will be provided to NHS England on a monthly basis. Each new months’ data is appended to the existing dataset until all files for a financial year have been published. Data is added to the database on 4th of each month and a report is normally published around the third Thursday of the month.

NHS England do not hold any identifiable Diagnostic Imaging Data. NHS England will not link Diagnostic Imaging Data to any other data set.

All individuals with access to the record level data are employees of NHS England and no third party will have access to the record level Diagnostic Imaging Data.

NHS England will retain a maximum of five complete years of data at any point in time (with older years to be destroyed as newer data is provided).

Aggregated data is produced on a monthly basis, using accumulated annual figures, with small numbers suppressed in line with the HES analysis guide. This is published as an official statistic, conforming to National Statistics protocols on a public website https://www.england.nhs.uk/statistics/statistical-work-areas/diagnostic-imaging-dataset/

In additional to production of the official statistics, NHS England will use the Diagnostic Imaging Data to produce ad-hoc reports and analyses for the purposes outlined in the objective for processing section.

All outputs will be aggregated with small numbers suppressed in line with the HES analysis guide. No third party will have access to any record level Diagnostic Imaging Data.

Outputs already produced:

Official statistics from the Diagnostic Imaging Data set have been published by NHS England (previously Dept of Health) monthly since 2012-13. In addition, annual reports and additional analyses have been published for 2012-13 to 2017-18.

Key statistics include:

• Number of diagnostic tests performed

• Period from referral to test

• Period from test to the test report being issued

These measures are reported for nine key modalities including X-ray, Ultrasound, CT and MRI scans.

In addition, data are published for a subset of tests that are particularly used to identify or discount a diagnosis of cancer.

These statistics are published for England and by Provider on a monthly basis and additionally by Commissioner on an annual basis. They are accompanied by information on data quality, coverage and completeness. Additional annual analyses include:

• Annual reports incorporating maps and additional analysis by age, sex, referral source and Provider

• Annual technical reports that further explain and describe the data collected

• Standardised imaging rates by CCG, showing the variation in provision

• Supplementary information on other modalities

• A comparison of 2013-14 Diagnostic Imaging Data imaging activity with other data sources: DM01 and KH12.

In addition to the material published on the NHS England web pages, NHS England produce ad hoc analyses to respond to queries raised by our clinical or policy contacts and others via the contact address did@dh.gsi.gov.uk.

Examples of the outputs and associated benefits of these analyses include:

• Rates of CT virtual Colonoscopy and Barium enema, which were compared with endoscopy rates (from HES) to show areas of best practice

• Cardiac imaging comparisons, showing relative proportions of CT and MRI activity

• Analysis by day of the week, to inform the debate around 7-day services

• Evaluation with CRUK of ‘Be Clear on Cancer’ initiatives such as for ‘Blood in pee’ and Lung cancer, by demonstrating increased diagnostic activity in periods and areas of the publicity campaigns

• Usage of individual NICIP or SNOMED CT codes, to review changes in coding practice

• Additional analysis to compare Diagnostic Imaging Data waiting times with DM01, to investigate delays around diagnostics

• Contributions for consideration or use in the Diagnostic Atlas of Variation published by Rightcare at http://www.rightcare.nhs.uk/index.php/atlas/diagnostics-the-nhs-atlas-of-variation-in-diagnostics-services/

• Data quality analyses, to work together with NHS Digital to improve the completeness and usability of Diagnostic Imaging Data.

NHS England will utilise Diagnostic Imaging Data to continuously:

• Monitor and improve diagnostic imaging services, by measuring access to imaging services

• Improve cancer survival rates by reducing referral to treatment times and diagnosing cancers earlier

• Reduce unnecessary exposure to radiation by monitoring compliance with clinical guidelines

Benefits achieved to date

The reported measures for nine key modalities including X-ray, Ultrasound, CT and MRI scans. This provides more information on NHS provision of these services than any other resource and is the only source of national information on some modalities.

The trends and patterns of provision demonstrate where there is scope for improving the early of diagnosis of cancer, in particular highlighting the share of referrals made by GPs.

NHS England has continued to utilise Diagnostic Imaging Data to:

- Monitor and improve diagnostic imaging services, by measuring access to imaging services

- Improve cancer survival rates by reducing referral to treatment times and diagnosing cancers earlier

- Reduce unnecessary exposure to radiation by monitoring compliance with clinical guidelines

Benefits achieved to date

- The reported measures for nine key modalities including X-ray, Ultrasound, CT and MRI scans. This provides more

information on NHS provision of these services than any other resource and is the only source of national information on

some modalities.

- The trends and patterns of provision demonstrate where there is scope for improving the early of diagnosis of cancer, in particular highlighting the share of referrals made by GPs.

- The published Diagnostic Imaging Data statistics have also been used by third parties such as CQC (to help with Ionising Radiation (Medical Exposure) Regulations compliance), PHE (Population radiation exposure) and NHS Improvement, giving essential information to support their work.