Standard Extract Subscription Renewal (HES)

MedeAnalytics International Limited (“MedeAnalytics”) is a commercial organisation that provides customers with national comparators for a range of quality and performance metrics that are derived within the MedeAnalytics UKMede system that uses HES data. MedeAnalytics provides an online service to customers that are limited to clinical commissioning groups, care quality commission registered providers and public health departments, accepting data, storing it in the central repository, then providing online analytics and reporting services. Where a client of MedeAnalytics is an independent sector provider, data from NHS Digital can only be used in support of their NHS-commissioned work.

In order to provide these services to their customers, MedeAnalytics require monthly HES data of a pseudonymised and non-sensitive nature. The record level HES data is not linked with any other data.

The data is processed under GDPR Article 6 (1) (f) and Article 9 (2) (j). MedeAnalytics legitimate interests are a necessary and lawful basis for processing and controlling HES data, as this enables MedeAnalytics to assist Customers with the access and use of medical analytics products and services, and the development of the same. MedeAnalytics considers access to its analytics to be in the public interest as well as of critical value to end-user Customers, so they can better understand their patient pools and make better health and social care decisions. The legitimate interests also include for MedeAnalytics to continue as a leading provider of mission critical medical analytics in the UK, and as well to support compliance with the NHS’ clinical and non-clinical performance expectations, using MedeAnalytics solutions to identify clinical domains where there are significant outliers, enabling Customers to prioritise service redesign activities.

The legal bases that MedeAnalytics rely upon to process the pseudonymised data under this Agreement is to support these providers so they can better understand their client pools, and for commercial purposes to continue as a leading provider of critical medical analytics in the UK.

Use cases supported by the MedeAnalytics system include commissioning activities, operational and financial activities, comparators and indicators, case identification, data quality validation, and the informing of direct patient care support.

By using HES data to compare activity from one region to another MedeAnalytics’ customers use the UK Mede platform to identify clinical domains where they are significant outliers. This enables them to prioritise their service redesign activities. HES is also used to produce baselines for a number of outcome metrics (eg amputations, acute kidney injury, or myocardial infarctions) that are derived from HES, these are then used for outcome based contracts. Six years of data available (5 previous complete years plus the partial current year) provides historical context and enables the correct identification of true outliers. The platform based on HES is used by operational, clinical and financial staff, to inform the better use of services and resources, and ultimately better patient outcomes.

The data required from NHS Digital is unfiltered personal healthcare HES data at pseudonymised and non-sensitive level of which includes all entries in HES Admitted Patient Care, Outpatient, A&E and Emergency Care datasets across England. The fields requested within each dataset have been minimised to only include those needed for the purpose described in this Agreement.

In some circumstances, the customers use third parties to analyse data on the system – they might include individual consultants, contracted staff or consultancy firms who have a contract with MedeAnalytics’ customer and are therefore acting as their agents. Any access to data by MedeAnalytics' customers is only ever access to aggregated data, with small numbers suppressed in line with the HES Analysis Guide.

MedeAnalytics International Limited is the data controller and also processes the data for this service. No other organisations process the data for this purpose.

The MedeAnalytics system provides information to a range of NHS and Social Care staff (including commissioners, service managers and clinicians, with responsibilities for operational, financial and clinical activities). The MedeAnalytics UK Mede system is a platform that is run on HES to produce graphs, charts, reports and dashboards specifically geared to the needs of each user. The outputs of the system are at a summary level - i.e. aggregated data (with small numbers suppressed in line with the HES Analysis Guide), users do not have access to event level or person level data.

HES data is accepted into MedeAnalytics’ secure, FTP service (which is accessible from an N3/HSCN connection).

On landing, initial data quality checks are undertaken (e.g.: to ensure that the correct number of records have been received, that it is not a duplicate transmission). Only substantive employees of MedeAnalytics have access to this data.

Upon successful download of data, the ETL (Extract, Transform and Load) process is run against the data to receive, normalise and upload the Data into MedeAnalytics' central databases. ETL processing includes the following:

• Extract (data receipt/collection, cleanse, parse and pre-processing)

• Transform (aggregation, normalise, apply business rules)

• Load (OLAP cube processing and database load)

• Data integrity and reconciliation (pre and post ETL)

• Performance tuning (DB indexing and data cache)

• Trending archive and meta data repository and file back-up management

• Production testing and QA

During Transformation processing, algorithms are run to create derived data from the data stream. Derived fields are stored alongside the original data as additional fields that allow different levels of obfuscation based upon Roles Based Access Controls (RBAC).

The retention period is the current NHS year plus five previous years for historical comparisons. At the end of the retention period, MedeAnalytics removes expired data and can provide appropriate destruction certificates. The reason that a longer period is needed is to provide a robust timeline with at least 4 data points to establish the baseline and trend for the management of outcome-based contracts. Three years would provide only 2 data points and the confidence limits are too wide to be useful. Statisticians have advised MedeAnalytics that 4 data points is the minimum.

MedeAnalytics can confirm that it has complied with all previous data deletion requests.

Please note: MedeAnalytics will only process data in the Back up/Disaster Recovery Centre in the event of a disaster that renders the primary data centre inoperable, and occasionally (no more than once per year) to test that the back-up/Disaster Recovery system is functional. Normal data processing is performed at the primary data centre.

All organisations party to this agreement must 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).

Where a client of MedeAnalytics International Limited is an independent sector provider, data from NHS Digital can only be used in support of their NHS-commissioned work.

Data that is presented in aggregated form (with small numbers suppressed in line with the ICO anonymisation standard), will comply with the HES Analysis Guide.

The MedeAnalytics system provides information to a range of NHS and Social Care staff (including commissioners, service managers and clinicians, with responsibilities for operational, financial and clinical activities). The MedeAnalytics UK Mede system is a platform that is run on HES to produce graphs, charts, reports and dashboards specifically geared to the needs of each user. The outputs of the system are at a summary level i.e. aggregated data, users do not have access to event level or person level data. Where analysis produces small numbers these are suppressed in line with the HES Analysis Guide.

The outputs derived from HES data allow comparisons between the customer's organisation or population and others nationally for a range of performance metrics such as lengths of stay, emergency admissions, A&E attendance etc. These National comparators are used by NHS organisations to improve the quality of care delivered by comparing their performance as set out by a specific range of care quality and performance measures, detailed activity and cost reports. The comparators are also used in service redesign and Health Needs Assessment (identifying underlying disease prevalence within the local population compared with the national picture). A customer typically looks at areas of activity that they are outliers for and use these as a way of prioritising service redesign activity and to target areas of deeper analysis and service improvement using more detailed data sources.

As the platform allows for self service analytics MedeAnalytics cannot give a comprehensive list of all the commissioning purposes the system is used for however some examples of how the system is being used are included. Usage of the MedeAnalytics Solution is governed under the UK Data Protection Act and NHS regulations and guidance (including the Care Act) as well as the specific terms of the contracts entered into between MedeAnalytics and its clients.

In addition, the data is used to produce comparative baselines of outcomes and will enable commissioners and providers to identify clinical areas to prioritise and to take the first steps on the path to outcomes-based contracts. The HES based MedeAnalytics system will be used to set baselines in these contracts (often contracts of five or more years). Performance is measured against these historical baselines and the trends calculated to drive payment.

Baseline trends used to set trajectories must be robust (i.e. avoiding spikes or dips in the data due to changes in coding practices for example). When creating a best-fit line (regression line) for trajectory setting, an absolute minimum of three complete years of baseline data are required to have a reasonable degree of confidence, although five years of baseline data are preferred to ensure accurate trend lines, to allow for evaluation of statistical significance of year-on-year changes, and associated confidence intervals. This is essential when setting outcomes-based contract trajectories as the extent to which true change is expected to occur must be determined.

Outputs from the system are used by clinical, financial and operational staff, across all levels including management, and are frequently used in board papers. Live access to the MedeAnalytics system (primarily through mobile devices) is used during board meetings to support operational decisions and answer live questions. HES (or HES-derived) data presented via the tool complies with the ICO anonymisation standard. Access is limited to UK users (England, Northern Ireland, Scotland and Wales) by browser location controls. IP addresses not registered in the UK are blocked from accessing the system. Access to Isle of Man users will also be permitted under this agreement, as if the Isle of Man were part of the UK.

The data items that users are able to access depend on each individual user's rights and the multi-dimensional role to which they are assigned. This means that users have access only to the relevant subset(s) of data contained in the tool.

Users of MedeAnalytics’ HES data service use it specifically to analyse activity, demands, outcomes and variations of services, by combinations of geography (to LSOA level), provider, demographics (age and gender) and time period.

Through such analysis, users of MedeAnalytics’ HES data service expect to be able to gain better insights into the services they provide, and how they compare both to self-selected peers, and to national trends and averages.

Better insights gained through analysis are expected to:

- inform service redesign activities,

- help to better understand the causes and impacts of changes over time,

- identify the impacts and results of redesign,

- Highlight where others are performing similar activities but achieving different results, allowing identification and investigation of best practice methods to improve their own performance

The platform based on HES will therefore inform the better use of services and resources, and ultimately, lead to better patient outcomes.

Benchmarking A&E activity at HRG level identified one main provider as an outlier for the recording of A&E attendance for resuscitation treatment. As a result, a deep dive of SUS data revealed that activity was being miscoded as resuscitation instead of provision of oxygen in A&E with a resulting cost pressure of £170 per patient. Through a challenge process, the provider made adjustments to coding of activity in the A&E department and as a result, the cost of activity was reduced going forward and a credit of £90k made to the commissioner. Incidentally, this issue has arisen again with another provider and was identified using the MedeAnalytics system to review HES data. This is also now being challenged through the contracting route.

HES benchmarking was utilised during 2017 to provide data to commissioners in the CCG relating to diabetes unplanned admissions and lower limb amputations. As a result of the benchmarking work, the CCG identified several areas of poor performance when compared to other similar CCG’s. This led to a bid for the funding of diabetes specialist nurses and associated diabetes pathway improvements which was successful and the CCG was awarded funding in the region of £190k to support the management of diabetics across Bedford Borough.