Data extract to support the continued accuracy of 3M developed quality and performance indicators for commissioners and providers.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Processing activities

There will be no flows of data to NHS Digital under this Agreement. [12 paragraphs unchanged]

Expected output

The output from 3M's processing of the pseudonymised HES data will be a large number of software-generated clinical indicators, flags and values. The relative frequency, utilization and patterns of relationship between these indicators is at the core of 3M’s validation process. These clinical indicators, flags and values will be checked internally by 3M United Kingdom PLC using specialist software and reporting tools that the data controller hopes will effectively validate the output and verify the ongoing accuracy of the 3M APR-DRG & 3M CRG software solutions when used with UK generated data. The validation and verification processes applied during this project should ensure that the insights health care providers, planners and commissioners derive from the 3M solution, are accurate, actionable and can deliver genuine benefits to the health of any UK population group they are applied to. The HES APC and HES OP data provided by NHS Digital to 3M is classified by NHS Digital as “Pseudonymised, Non-sensitive” and will never be linked with other datasets which could allow re-identification. The data will remain on a dedicated secure environment within 3M's UK IT enterprise, it will only be accessed by a restricted number of substantive employees of 3M and will never be accessed/processed by any other parties or shipped as part of any solutions developed by 3M. 3M’s validation will focus particularly on the accuracy of the 3M generated tables and associated algorithms which have been developed to support the use of UK generated clinical information (including clinical coding classifications and other NHS Data Dictionary items). Output from this process will contain only data that is aggregated, with small numbers suppressed, in line with the HES Analysis Guide, for example the prevalence of 3M generate chronic disease indicators would be compared with international benchmarks and publicly available UK national statistics (e.g. national incidence of Diabetes, COPD, Ischaemic Heart Disease etc.) and aggregated comparisons would be made with other clinical, productivity or quality indicators such as average length of stay or average number of interventions by APR-DRG, CRG, Chronic Disease Category etc. The validation of complex clinical categorical algorithms is a continuous process, the reason being is that 3M need to continuously validate changes to their CRG algorithm (which is designed, developed and maintained in the USA) to align with UK coding standards and content. All employees accessing the data must be UK based and belong to a specific security group and in order to join this group users must complete a questionnaire and provide a business justification for their access. Security administrators will review every request, assess the justification and approve the request if valid. Client Implementation: The HES data provided does not contain any Patient Identifiable data records\fields such as patient name, addresses, date of birth or NHS number. Although this pseudonymised HES data contains no field values classifiable by NHS Digital as sensitive or identifiable, 3M recognises this as special category data which constitutes personal data under GDPR and the Data Protection Act 2018. All employees authorised to process this HES data will be made fully aware of their responsibilities regarding the General Data Protection Regulation (GDPR) and 3M’s Standard on Handling Sensitive Health Information. Awareness is facilitated and monitored via an on-going role-based training program. Once validated, the 3M APR-DRG and 3M CRG software solutions will be available for purchase by 3M clients (NHS Trusts, ICBs or CSUs). The data requested under this Agreement will not be included or in any way embedded within the 3M software deliverables. The 3M software solutions will be deployed by 3M clients, consume 3M clients’ own information and the clinical indictors, flags and values generated by 3M solutions will be incorporated into dashboards and reports all within 3M clients’ own IT environment. Below is an iterative process that will be repeated until the crosswalk tables and algorithms are deemed as accurate as possible for the NHS experience. Key outputs expected from the software: • The original pseudonymised HES data has been downloaded to a nominated folder on the secure server. 3M™ Clinical Risk Groups (CRG) system (includes but is not limited to) • The data for the year in focus will be extracted. • CRG – a code that classifies each individual processed by disease burden, the severity level of that burden and their overall health status (current and prospective). • Specialist software routines will cleanse that data and convert UK specific data items to their international equivalents using 3M developed crosswalk tables and algorithms • ACRGs – aggregated variants of the CRG (5 levels) (current and prospective). • The converted data will then be formatted and processed through the two software solutions being validated: 3M™ All Patient Refined DRGs (APR DRG) and 3M™ Clinical Risk Groups (CRGs) • MDCs – a list of Major Diagnostic Categories assigned to each individual processed • The very many output fields from these solutions (quality and performance indicators, flags and values) will be loaded into a database for subsequent analysis • EDCs – Episode Disease Categories • Reports will be run in that database environment that will compare and contrast combinations of the output data generated with international patterns of distribution and other comparative output criteria (national statistics on chronic diseases etc.). • EPCs – Episode Procedure Categories 3M will use five years’ worth of HES data to produce and perform the necessary validation. This is to allow sufficient historic comparison of previous years quality and performance indicators. 3M™ All Patient Refined DRGs (APR DRG) system (includes but is not limited to) All outputs will be aggregated with small numbers suppressed in line with HES analysis guidelines. • APR-DRG – a code that classifies every episode of care delivered to an individual • SOI – Severity of Illness indicator for that episode of care • ROM – Risk of Mortality indicator for that episode of care • PPA – Potentially Preventable Admissions indicator • PPR – Potentially Preventable Re-admissions indicator • PPC – Potentially Preventable Complications indicator Since these 3M solutions are continually evolving to improve their scope, their relevance and ultimately their value to 3M’s clients (and the populations in their care), 3M will require long-term access to this data for statistical, trending and longitudinal validation purposes. It will be necessary to hold a rolling body of 5 years data - by way of example, once the 2017/18 annual refresh data was received and processed 3M have deleted the 2012/13 HES data in accordance with NHS Digital guidance and 3M have provided confirmation of the secure and permanent destruction to NHS Digital in the form of a Certificate of Destruction. which has been approved by NHS Digital. 3M Relationship with IQVIA- 3M supplies IQVIA with their 3M CRG population segmentation/stratification software for incorporation into their own ICS Manager solutions, the 3M CRG software has been bench-tested and validated for use with NHS data in the UK by using the data held under this agreement. 3Ms work with IQVIA is covered under a confidential commercial agreement (reseller agreements), no Data 3M has received via this agreement is shared with IQVIA, however IQVIA incorporate content generated by the 3M CRG algorithm (CRGs, ACRGs, DSGs, MDCs etc.) into a number of IQVIA solutions targeted at the ICS market 3M have engaged with several organisations regarding the use of the tools created using the data under this agreement. Most of these engagements are in the early stages and have not yet produced any outputs, except for the work that 3M has undertaken with The Rotherham Hospital NHS Foundation Trust (NHSFT). An agreed pilot with The Rotherham Hospital NHSFT to use 3M CRGs to profile (stratify and segment) by the burden of illness the users of their Same-Day Emergency Care (SDEC) services was signed of in March 2022. The pilot commenced in May 2022. The purpose of the pilot was to stratify and segment the patients accessing their Same-Day Emergency Care (SDEC) services using 3M CRGs. The key findings from the pilot with the Rotherham Hospital NHSFT included :- - 3M were able to successfully profile the SDEC population attending The Rotherham Hospital NHSFT in 2020-2022, using 3M CRGs and highlight a number of Care Management Opportunities for the trust; specifically that lower severity single & double chronic patients account for nearly of 90% of the chronic SDEC population and that hypertension was the dominant chronic condition amongst attendees which would suggest and investment in antihypertensive therapy in the community could significantly alleviate pressure on this service. Other areas of focus would include mental health services (targeted especially at female millennials), obesity and osteoarthritis. - A cohort of 36 individuals were identified with multiple chronic diseases that would most likely benefit from improved co-ordinated, person-focused care (“high priority cases for care management”). - With 3M CRGs 3M were able to demonstrate that the presence of a mental health condition more than doubles expected hospital days across the SDEC population and the impact of mental health increased by patient acuity; co-ordination with primary care and community-based services are opportunities for improvement in treating physical / mental care in combination. - In the broader control population (all patients) 3M were able to demonstrate that over 16% of all chronic patients in 2020-2021 moved into higher chronic disease statuses in 2021-2022 and over half of all health status jumpers moved from having a single chronic disease to having two chronic diseases. The value of his insight being that studying trends in the CRG severity & status jumper populations can provide opportunities for both: i)Studying the impact of primary care’s management of chronic disease ii)Coding initiatives / coding audit and clinical data validation to make sure granularity of severity in chronic disease is being captured to profile (stratify and segment) by the burden of illness on the users of their Same-Day Emergency Care (SDEC) services. The outcome of this pilot led to Rotherham Hospital NHSFT making the decision to use 3M CRGs to more accurately define Rotherham Hospital NHSFT’s SDEC cohort in terms of the current and the longitudinal burden of illness to understand if Rotherham Hospital NHSFT are seeing sicker patients now than they did 3 years ago, which disease combinations are becoming more prevalent and what services they should put in place (in association with their primary care providers) to meet that escalating need and reduce the pressure on an already stretched service in SDEC. Additionally, by linking the 3M CRG data to geographic information, Rotherham Hospital NHSFT hope to see which areas of Rotherham are experiencing the greatest acceleration of burden of illness of their SDEC population, what are the key drivers of that acceleration (Chronic Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes etc.) and build a schema of prioritisation for those interventions. Update October 2022 - There are two key themes for planned continued engagement with Rotherham Hospital NHSFT:- 1) Work with The Rotherham Office of Data Analytics (RODA) [an affiliate organisation to The Rotherham Hospital NHSFT] to embed the clinical categorical insight from 3M CRGs into the broader aspects of Population Health Management reporting and analysis. The current project with The Rotherham Hospital NHS Foundation Trust involved very little administrative data and no socio-economic or geographic data, by incorporating the project output with the data held by RODA 3M can deliver more meaningful comparisons of the SDEC population across: • Primary Care Networks • Postcodes and Indices of deprivation • Consumption of community/ancillary services • Admission Rates (with a focus on admissions for Ambulatory Care Sensitive Condition) • Re-admission Rates • Prescription costs • Visits to GPs/Emergency Departments etc. 2) The Rotherham Hospital would like to promote 3M CRGs to a wider audience, one that would allow 3M to onboard and process data from settings other than just secondary care (e.g. primary care, community care, mental health etc.). This would create a much richer dataset for processing, this will require 3M to present the findings of the current project and deliver a joint proposal to the South Yorkshire and Bassetlaw Integrated Care System (SYICS)

Unchanged: Objective for processing, Expected measurable benefits, Benefits reported.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

3M United Kingdom PLC (3M), the largest provider of dedicated coding and grouping software solutions (3M) aims to the NHS (covering both commissioners and providers), are currently working work with a number of their NHS clients, clients to implement in the UK a software that has been successfully deployed by 3M 3M™ in the US United States for over 15 years; years. It is hoped this software can will significantly accelerate the NHS England’s move towards a more Population Health Management focused health service. [3 paragraphs unchanged] 3M wish to retain and process the five years of pseudonymised Hospital Episode Statistics (HES) already received under the previous iteration v 5.4 of this agreement, in order to validate and refine these complex clinical algorithms and ensure they remain tuned as accurately as possible to the NHS experience. 3M Clinical Risk Groups (CRGs) purpose is to give a deeper insight into the clinical complexity of a given population, meaning that 3M can distinguish between patients who may share the same diagnosis but at the same time differ widely in their severity of illness, overall health status and ultimately their projected use of healthcare resources etc. By processing these volumes of HES data to verify the anglicisation of these solutions, 3M hope to be able to directly support the NHS both from a commissioning and provider role in identifying people’s health needs and intervening appropriately to address them. HES Critical Care Data previously received was destroyed in April 2020. During the course of this 12-month Agreement, 3M will not be focusing on the All Patient Refined Diagnostic Related Groups (APR-DRG) because it's validation and introduction to the UK will commence once Clinical Risk Groups (CRG) are established in the UK and as a result of this Critical Care data is not required for validation purposes. As well as supporting intervention, 3M CRGs and APR-DRGs can be used for stratifying populations, risk adjustment, predicting healthcare utilisation and cost, tracking health outcomes, and analysing the health of populations. For healthcare providers and planners, failure to include adequate risk adjustment in their population health management modelling can result in the inequitable distribution of financial and other resources which may ultimately affect (negatively) the quality of care given to those individuals most in need of it. The HES data requested is Admitted Patient Care and Outpatient attendance data. 3M will process the data obtained under this Agreement in line with it's legitimate commercial interests. 3M have been awarded places on two Lots of the NHS England Health System Support Framework (HSSF) which may be accessed by public sector bodies that are engaged in the management and/or support of the health, care and/or wellbeing of populations within the UK: HES Critical Care (CC) data was received under a previous version of this Agreement alongside HES Admitted Patient Care and HES Outpatients data. However under this Agreement 3M will no longer be focussing on the All Patient Refined Diagnostic Related Groups (APR-DRG) because its validation and introduction to the UK will commence once Clinical Risk Groups (CRG) are established in the UK, and as a result of this HES Critical Care data is not required for validation purposes. Therefore the HES CC data previously disseminated was destroyed in in April 2020. The HES data now required is Admitted Patient Care and Outpatient attendance data. 3M already hold this data on a rolling, 5-year basis. The HES data requested contains no field values classifiable by NHS Digital as sensitive or identifiable, however 3M recognises this does contain pseudonymised data and is classed as personal data. 3M will use five years’ worth of HES data to produce and perform the necessary validation. This will allow sufficient historic comparison of previous years quality and performance indicators and appears in-line with the expectations and requests of previous applications. 3M require continued retention of the HES data already held to support the validation of complex clinical categorical algorithms is a continuous process, 3M need to continuously validate changes to their own CRG algorithm (which is designed, developed and maintained in the USA) to align with UK coding standards and content. 3M are conscious and have discussed internally whether the aged data they hold is still successfully informing the algorithm. The changes to ICD ad OPCS are relatively minor and well understood (3M provide the coding, grouping and data quality know-how to approximately 85% of the NHS acute care market) and having a stable comparable data set means 3M are able to focus on the impact amendments to their algorithm have made on a stable longitudinal dataset. 3M UK Clinical leads have discussed the significant impact COVID has had on the profile of care delivered in UK NHS Hospitals, and that the aged data 3M hold, therefore, contains a more representative spread of clinical care. In 2023/2024 3M will be looking to move the aged data forward so that the most recent year of the 5-year data analysis window will be 2022/23. The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. Clinical risk algorithms need to have sight and understanding of disease progression and the level and nature of disease co-morbidities to accurately assign risk categories. Additionally the 3M software is continually being developed and refined by 3M's clinical experts, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions – restricting the test data by geographic, demographic or clinical factors would severely undermine that validation process. The complex clinical algorithms involved here are designed to work on entire populations as the filtering question to restrict the test data by episode type would similarly undermine that validation process. With specific regard to neonate and child records, the 3M algorithms have been developed with input from the National Association of Children's Hospitals and Related Institutions (NACHRI) and are particularly good at measuring the illness burden of medically complex children. As such this research provides 3M with evidence to support the justification for the use of young person's data in this request. 3M will follow a process of re-validation of the live tool (ensuring it adequately reflects changes in HES data over time) thus the requirement to retain and process HES data to ensure this can be adequately validated is requested. 3M will take current data and validate the 3M CRG clinical model that was built. Having recent data allows 3M to validate the alignment of the 3M CRG Methodology with the reflected change in the data due to regulations and updated national guidance. 3M have been awarded places on two Lots of the NHS England Health System Support Framework (HSSF) which may be accessed by public sector bodies that are engaged in the management and/or support of the health, care and/or wellbeing of populations within the UK: [2 paragraphs unchanged] and in line with Article 6(1)(f) and Article 9(2)(j) of the General Data Protection Regulation (GDPR). 3M will process the personal and special category data obtained under this Agreement in line with its legitimate interests, using Article 6(1)(f) of the General Data Protection Regulation (GDPR), and in line with Article 9(2)(j), the processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject. Although the licenced Hospital Episode Statistics (HES) data contains no field values classifiable by NHS Digital as sensitive or identifiable, 3M recognises this does contain pseudonymised data and will therefore treat it as personal and special category data under GDPR and the Data Protection Act 2018 and as such 3M UK Plc processes this special category personal data for the purposes of its legitimate interests under Articles 6(1)(f) and 9 (2)(j) of the GDPR - The data are required for research purposes in the public interest – meeting the conditions in the DPA 2018 Schedule 1 Part 1 (4) - which GDPR Recital 52(2) determines is an appropriate derogation from the prohibition on processing special categories of personal data. The ways in which the processing of data will be of benefit to the public – thereby demonstrating that the processing is in the public interest – are described in section 5d. ii. Expected Measurable Benefits to Health and/or Social Care Including Target Date’. The data controller has completed a Legitimate Interest Assessment (LIA) to document the conclusion on the lawfulness of the processing. - In accordance with GDPR Article 89(1) processing is subject to appropriate safeguards. These include: Specifically, in regard to the three-part test: i. The data will be pseudonymised prior to dissemination by NHS Digital to the data recipient. ii. The data recipient’s technical and organisational measures to safeguard the data have been assessed and meet NHS Digital’s acceptance criteria (see sections 2 and 5b of this application for further details); iii. The requested data has been assessed as proportionate to the aim pursued (see section 5a of this application for further details); iv. Controls, data retention and processing activities have been assessed to ensure respect to the essence of the right to data protection (see sections 5a, 5b and 8a of this application for further details); v. Measures to protect the rights and freedoms of data subjects have been assessed including transparency (fair processing) publishing subjects’ rights to withdraw consent and/or have their data erased or rectified, etc. 3M’s justification for using Article 9(2)(j) is that the adoption by the NHS of their solutions, principally 3M All Patient Refined (APR)-Diagnostic Related Grouper (DRG)s and 3M Clinical Risk Grouper (CRG)s, requires that they be fully tested and ensured as fit-for-purpose for use in UK health service. The only way to achieve this is to statistically analyse and iteratively refine the performance of those groupers (and their relevant cross-walks) with significant volumes of data such as HES. Article 6(1)(f) of the GDPR applies; processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party except where such interests are overridden by the interests of fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Therefore the data controller has completed a Legitimate Interest Assessment (LIA) to document the conclusion on the lawfulness of the processing, details of which are summarised as: [3 paragraphs unchanged] 3M is working aims to work with NHS clients (including NHS England) to implement in the UK a technology that has been successfully deployed [22 words unchanged] Grouper (CRG)s. The NHS will have access to enhanced data sets that will should better help them better plan and analyse: [9 paragraphs unchanged] The key indicators derived from the 3M solution (Clinical Risk Category, Health Status, Risk of Mortality, Severity of Illness etc.) will may help the NHS better perform its duties by highlighting actionable areas for clinical and process improvement; “improved data leads to improved decisions” [3 paragraphs unchanged] A smaller data sample would not provide as complete a picture of the disease burden across the country as the data we 3M have requested, and a smaller data sample would not offer assurance to [5 words unchanged] 3M’s solutions are tuned as accurately as possible to the NHS experience. In terms of processing the data in another more obvious or less [10 words unchanged] have no sensitive or identifiable content fields (as determined by NHS Digital) we they are meeting those twin goals. [2 paragraphs unchanged] This HES extracted HES-extracted data comprises a longitudinal record of all admissions and outpatient appointments at [52 words unchanged] Hospital Association to ensure these algorithms address the needs of paediatric populations. Additionally, the HES data 3M will use is not obtained directly from patients but from hospital provider systems via the Secondary Uses Service (SUS) and the 3M extract includes no field values classifiable by NHS Digital as Sensitive or Identifiable. 3M is the sole data controller and the only organisation processing the data received under this Agreement. This data will be used by 3M United Kingdom PLC as an enabler, it will only be used for analytical purposes to validate the anglicisation and commercialisation of the 3M APR-DRG and 3M CRG software solutions. The public understand that the NHS is changing and that new care models are being developed to improve population health and, in addition, that the NHS has a direct role to play in identifying people’s health needs and intervening appropriately to address them. There is an understanding that data about people’s health needs to be used to identify groups within a given population that would benefit from different types of support. A foundational building block for the implementation of population health management is risk stratification and segmentation, 3M Clinical Risk Groups (CRGs) are a clinically based classification system for measuring a patient’s burden of illness, as opposed to regressive statistical systems (which are more typical of the wider European market at present). Their purpose is to give a deeper insight into the clinical complexity of a given population, greater insight meaning that 3M can distinguish between patients who may share the same diagnosis but at the same time differ widely in their severity of illness, overall health status and ultimately their projected use of healthcare resources etc. By processing these volumes of HES data to verify the anglicisation of these solutions 3M will be able to directly supports the NHS both from a commissioning and provider role in identifying people’s health needs and intervening appropriately to address them. The data requested will not be included or in any way embedded within the resultant software solutions and will not be provided in record-level form to any third party or similarly onward transmitted. As well as supporting intervention 3M CRGs and APR-DRGs can be used for stratifying populations, risk adjustment, predicting healthcare utilisation and cost, tracking health outcomes, and analysing the health of populations. For healthcare providers and planners, failure to include adequate risk adjustment in their population health management modelling can result in the inequitable distribution of financial and other resources which will ultimately affect (negatively) the quality of care given to those individuals most in need of it. Commercially the 3M™ All Patient Refined DRGs (APR DRGs) and 3M™ Clinical Risk Groups (CRGs) software will be made available to health authorities through annual software licence (ASL) agreements which will allow the authorities (STPs [Sustainability and Transformation Partnerships], LHCREs [Local Health and Care Record Exemplar] , ICS's [Integrated Care Systems] etc.) to process their own locally generated population health data through these solutions as many times as they wish during the licence period. Typically an organisation will connect the software on their own IT network and process their entire population through these solutions when they first acquire the capability, they would then reprocess groups of individuals as new or amended data becomes available in order to ensure their understanding of their population remains as accurate as possible. In terms of visualising the insight proceeded by the 3M software the additional data fields generated from this processing (CRGs, ACRGs, MDCs, DSGs etc. – see outputs section.) will typically be incorporated into the licensees own population health management database and interrogated using the business intelligence tools the licensee and their analytical teams are already familiar with. The purpose of adopting these 3M solutions is not to provide the NHS with another analytical tool but to empower the systems of insight they already possess by significantly improving the depth and breadth of data in their underlying systems of record; improving the single source of truth. 3M is the sole data controller and only party processing the pseudonymised HES data from this request will be used internally by 3M United Kingdom PLC as an enabler, it will only be used for analytical purposes to validate the anglicisation and commercialisation of the 3M APR-DRG and 3M CRG software solutions. There are no further funders or commissioners involved in this project that have not been mentioned in this agreement. The data requested is an enabler, it will not be included or in any way embedded within the resultant software solutions and will not be provided in record level form to any third party or similarly onward transmitted. Data Minimisation: 3M have reduced the number of datasets requested on this renewal, 3M will no longer request the Critical Care data set and have provided evidence of data destruction to NHS Digital.. 3M are requesting to retain and process pseudonymised data and have asked for no fields values classifiable by NHS Digital as sensitive or identifiable. 3M will use five years’ worth of HES data to produce and perform the necessary validation. This will allow sufficient historic comparison of previous years quality and performance indicators and appears in-line with the expectations and requests of previous applications. 3M have made this data request in order to validate and refine a number of these complex clinical algorithms and ensure they remain tuned as accurately as possible to the NHS experience The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. Clinical risk algorithms need to have sight and understanding of disease progression and the level and nature of disease co-morbidities to accurately assign risk categories. Additionally the 3M software is continually being developed and refined by 3M's clinical experts, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions – restricting the test data by geographic, demographic or clinical factors would severely undermine that validation process. The complex clinical algorithms involved here are designed to work on entire populations as with the filtering question to restrict the test data by episode type would similarly undermine that validation process. With specific regard to neonate and child records the 3M algorithms has been developed with input from the National Association of Children's Hospitals and Related Institutions (NACHRI) and is particularly good in measuring the illness burden of medically complex children. As such this research provides 3M with evidence to support the justification for the use of young person's data in this request. 3M will follow a process of re-validation of the live tool (ensuring it adequately reflects changes in HES data over time) thus the requirement to retain and process HES data to ensure this can be adequately validated is requested. 3M will take current data and validate the 3M CRG clinical model that was built. Having recent data allows 3M to validate the alignment of the 3M CRG Methodology with the reflected change in the data due to regulations and updated national guidance.

Processing activities

All organisations party to this agreement will 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 i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). There will be no flows of data to NHS Digital under this Agreement. 3M United Kingdom PLC (3M) is the data controller for this request and will be processing the data. The HES APC and HES OP data provided by NHS Digital to 3M is classified by NHS Digital as “Pseudonymised, Non-sensitive” and will never be linked with other datasets which could allow re-identification. The data will remain on a dedicated secure environment within 3M's UK IT enterprise, it will only be accessed by a restricted number of substantive employees of 3M and will never be accessed/processed by any other parties or shipped as part of any solutions developed by 3M. There will be no flow of data into NHS Digital from 3M. The only data transfer under this agreement will be the dissemination of the pseudonymised, non-sensitive HES data to 3M by NHS Digital. The HES data requested is classified by NHS Digital as “Anonymised/Pseudonymised, Non-sensitive” and will never be linked with other datasets which could allow re-identification. The data will remain on a dedicated secure environment within 3M's UK IT enterprise, it will only be accessed by a restricted number of substantive employees of 3M and will never be accessed/processed by any other parties or shipped as part of any solutions developed by 3M. [1 paragraph unchanged] The HES data provided through this DARS request does not contain any PID Patient Identifiable data records\fields such as patient name, addresses, date of birth or NHS number. [66 words unchanged] Information. Awareness is facilitated and monitored via an on-going role-based training program. Processing activities: Below is an iterative process that will be repeated until the crosswalk tables and algorithms are deemed as accurate as possible for the NHS experience. • The original pseudonymised HES data will be has been downloaded to a nominated folder on the secure server. [5 paragraphs unchanged] • This iterative process will be repeated until the crosswalk tables and algorithms are deemed as accurate as possible for the NHS experience. [1 paragraph unchanged] The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. The 3M software is continually being developed and refined by 3M's clinical and technical teams, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions. All outputs will be aggregated with small numbers suppressed in line with HES analysis guidelines.

Expected output

The data funder this Agreement will be used internally by 3M as an enabler, it will be used for analytical purposes to anglicise, validate and commercialise the 3M software solutions. The output from 3M's processing of the pseudonymised HES data will be a large number of software-generated clinical indicators, flags and values. The relative frequency, utilization and patterns of relationship between these indicators is at the core of 3M’s validation process. These clinical indicators, flags and values will be checked internally by 3M United Kingdom PLC using specialist software and reporting tools that the data controller hopes will effectively validate the output and verify the ongoing accuracy of the 3M APR-DRG & 3M CRG software solutions when used with UK generated data. The validation and verification processes applied during this project should ensure that the insights health care providers, planners and commissioners derive from the 3M solution, are accurate, actionable and can deliver genuine benefits to the health of any UK population group they are applied to. The data requested will not be provided in record level form to any third party or in any other way onwardly transmitted. No individuals, doctors, consultants, or patients from this data will ever be identified in 3M United Kingdom PLC products and all outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide. 3M’s validation will focus particularly on the accuracy of the 3M generated tables and associated algorithms which have been developed to support the use of UK generated clinical information (including clinical coding classifications and other NHS Data Dictionary items). Output from this process will contain only data that is aggregated, with small numbers suppressed, in line with the HES Analysis Guide, for example the prevalence of 3M generate chronic disease indicators would be compared with international benchmarks and publicly available UK national statistics (e.g. national incidence of Diabetes, COPD, Ischaemic Heart Disease etc.) and aggregated comparisons would be made with other clinical, productivity or quality indicators such as average length of stay or average number of interventions by APR-DRG, CRG, Chronic Disease Category etc. The validation of complex clinical categorical algorithms is a continuous process, the reason being is that 3M need to continuously validate changes to their CRG algorithm (which is designed, developed and maintained in the USA) to align with UK coding standards and content. Validation: The output from 3M's processing of the pseudonymised national data will be a large number of software generated clinical indicators, flags and values. The relative frequency, utilization and patterns of relationship between these indicators is at the core of 3M’s validation process. These clinical indicators, flags and values will be checked internally by 3M United Kingdom PLC using specialist software and reporting tools that will effectively validate the output and verify the on-going accuracy of the 3M APR-DRG & 3M CRG software solutions when used with UK generated data. The validation and verification processes applied during this project will ensure that the insights health care providers, planners and commissioners derive from the 3M solution, are accurate, actionable and can deliver genuine benefits to the health of any UK population group they are applied to. 3M’s validation will focus particularly on the accuracy of the 3M generated tables and associated algorithms which have been developed to support the use of UK generated clinical information (including clinical coding classifications and other NHS Data Dictionary items). Output from this process will contain only data that is aggregated, with small numbers suppressed, in line with the HES Analysis Guide, for example the prevalence of 3M generate chronic disease indicators would be compared with international benchmarks and publicly available UK national statistics (e.g. national incidence of Diabetes, COPD, Ischaemic Heart Disease etc.). and aggregated comparisons would be made with other clinical, productivity or quality indicators such as average length of stay or average number of interventions by APR-DRG, CRG, Chronic Disease Category etc. [1 paragraph unchanged] Once validated, the 3M APR-DRG and 3M CRG software solutions will be available for purchase by 3M clients (NHS Trusts, CCGs ICBs or CSUs). The data requested under this Agreement will not be included [38 words unchanged] incorporated into dashboards and reports all within 3M clients’ own IT environment. Key outputs expected from the software: [14 paragraphs unchanged] Activity to end of July 2020: 3M Relationship with IQVIA- - 3M have developed key marketing messages to the NHS, including features, advantages and benefits based on US, Spanish and Italian experiences 3M supplies IQVIA with their 3M CRG population segmentation/stratification software for incorporation into their own ICS Manager solutions, the 3M CRG software has been bench-tested and validated for use with NHS data in the UK by using the data held under this agreement. 3Ms work with IQVIA is covered under a confidential commercial agreement (reseller agreements), no Data 3M has received via this agreement is shared with IQVIA, however IQVIA incorporate content generated by the 3M CRG algorithm (CRGs, ACRGs, DSGs, MDCs etc.) into a number of IQVIA solutions targeted at the ICS market - 3M have presented their UK compliant solutions offering to a number of ICSs, STPs and software companies involved with data aggregation and population health management with a view to establishing a UK proof-of-concept/pilot implementation. 3M have engaged with several organisations regarding the use of the tools created using the data under this agreement. Most of these engagements are in the early stages and have not yet produced any outputs, except for the work that 3M has undertaken with The Rotherham Hospital NHS Foundation Trust (NHSFT). -Held discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation regarding pilot implementation at Cwm Taf University Health Board to support Population Health Management (PHM) initiative. An agreed pilot with The Rotherham Hospital NHSFT to use 3M CRGs to profile (stratify and segment) by the burden of illness the users of their Same-Day Emergency Care (SDEC) services was signed of in March 2022. The pilot commenced in May 2022. The purpose of the pilot was to stratify and segment the patients accessing their Same-Day Emergency Care (SDEC) services using 3M CRGs. Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA (November 2021) The key findings from the pilot with the Rotherham Hospital NHSFT included :- Activity to end of September 2020: - 3M were able to successfully profile the SDEC population attending The Rotherham Hospital NHSFT in 2020-2022, using 3M CRGs and highlight a number of Care Management Opportunities for the trust; specifically that lower severity single & double chronic patients account for nearly of 90% of the chronic SDEC population and that hypertension was the dominant chronic condition amongst attendees which would suggest and investment in antihypertensive therapy in the community could significantly alleviate pressure on this service. Other areas of focus would include mental health services (targeted especially at female millennials), obesity and osteoarthritis. - 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. - A cohort of 36 individuals were identified with multiple chronic diseases that would most likely benefit from improved co-ordinated, person-focused care (“high priority cases for care management”). - 3M have submitted joint bid with Frimley ICS to NHS England, NHS Improvement and SBRI to reduce ED demand by prevention using clinical and modifiable risk stratification - With 3M CRGs 3M were able to demonstrate that the presence of a mental health condition more than doubles expected hospital days across the SDEC population and the impact of mental health increased by patient acuity; co-ordination with primary care and community-based services are opportunities for improvement in treating physical / mental care in combination. Outcome: Although 3M/Frimley ICS bid made it to the final round of this procurement our bid was ultimately unsuccessful. - In the broader control population (all patients) 3M were able to demonstrate that over 16% of all chronic patients in 2020-2021 moved into higher chronic disease statuses in 2021-2022 and over half of all health status jumpers moved from having a single chronic disease to having two chronic diseases. The value of his insight being that studying trends in the CRG severity & status jumper populations can provide opportunities for both: - Discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation migrated to potentially much wider project to implement 3M CRGs in NHS Wales Informatics Service (NWIS) National Data Resource (NDR) i)Studying the impact of primary care’s management of chronic disease Outcome: This project was put on hold (and remains on hold) due to changing priorities brought about by the COVID-19 pandemic. ii)Coding initiatives / coding audit and clinical data validation to make sure granularity of severity in chronic disease is being captured to profile (stratify and segment) by the burden of illness on the users of their Same-Day Emergency Care (SDEC) services. Activity to end of December 2020: The outcome of this pilot led to Rotherham Hospital NHSFT making the decision to use 3M CRGs to more accurately define Rotherham Hospital NHSFT’s SDEC cohort in terms of the current and the longitudinal burden of illness to understand if Rotherham Hospital NHSFT are seeing sicker patients now than they did 3 years ago, which disease combinations are becoming more prevalent and what services they should put in place (in association with their primary care providers) to meet that escalating need and reduce the pressure on an already stretched service in SDEC. - 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. Additionally, by linking the 3M CRG data to geographic information, Rotherham Hospital NHSFT hope to see which areas of Rotherham are experiencing the greatest acceleration of burden of illness of their SDEC population, what are the key drivers of that acceleration (Chronic Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes etc.) and build a schema of prioritisation for those interventions. - 3M have submitted a joint bid with IQVIA to support Population Health Management programme at London Procurement Partnership. Update October 2022 - There are two key themes for planned continued engagement with Rotherham Hospital NHSFT:- Outcome: The IQVIA:3M bid was accepted and we are now part of the London Procurement Partnership Framework (March 2021) 1) Work with The Rotherham Office of Data Analytics (RODA) [an affiliate organisation to The Rotherham Hospital NHSFT] to embed the clinical categorical insight from 3M CRGs into the broader aspects of Population Health Management reporting and analysis. - 3M have continued discussions with NWIS regarding incorporation of 3M CRGs in National Data Resource The current project with The Rotherham Hospital NHS Foundation Trust involved very little administrative data and no socio-economic or geographic data, by incorporating the project output with the data held by RODA 3M can deliver more meaningful comparisons of the SDEC population across: Activity to end of March 2021: • Primary Care Networks - 3M successfully gained a place on the London Procurement Partnership framework via joint bid with IQVIA whereby their ICS Manager solution will utilise the 3M CRG Risk Stratification/Risk Segmentation methodology. • Postcodes and Indices of deprivation - 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies • Consumption of community/ancillary services - Cwm Taf Morgannwg University Health Board have entered into an agreement with 3M around improving health informatics part of that agreement is to launch a pilot programme for Population Health Management using the 3M CRG Risk Stratification/Risk Segmentation methodology. • Admission Rates (with a focus on admissions for Ambulatory Care Sensitive Condition) Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA (November 2021) • Re-admission Rates - Continued discussions with NWIS regarding the incorporation of 3M CRGs in National Data Resource • Prescription costs Activity to end of June 2021: • Visits to GPs/Emergency Departments etc. - 3M have continued to present the UK compliant solutions to ICSs, STPs and software companies. 2) The Rotherham Hospital would like to promote 3M CRGs to a wider audience, one that would allow 3M to onboard and process data from settings other than just secondary care (e.g. primary care, community care, mental health etc.). This would create a much richer dataset for processing, this will require 3M to present the findings of the current project and deliver a joint proposal to the South Yorkshire and Bassetlaw Integrated Care System (SYICS) - 3M are continuing the project planning and data processing tests successfully performed for proof-of-concept purposes (restricted sample dataset) with Cwm Taf Morgannwg University Health Board. Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA. (November 2021) - Presentation on 3M CRGs to support Population Health Management @ HIMSS-EU 2021 including the announcement of their availability in the UK - Project discussions with NHS Wales Informatics Service (NWIS) National Data Resource (NDR) put on hold (and remains on hold) due to changing priorities brought about by the COVID-19 pandemic Activity to end of September 2021: - As part of a consortia led by KMPG we responded to NHS England and Improvement’s ITT “Supporting population-based transformation and establishment of place-based partnerships HSSF21 – 079”, Outcome- 3M failed to win the tender but gained praise for the approach to population health management and these methodologies (3M CRGs and 3M APR-DRGs) - Presented 3M CRGs @ 5th NHS Data & Information Virtual Congress ca. 150 attendees, 13 leads generated which are actively being pursued Outcome: Leads were actively chased by 3M marketing team - 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. Activity to end of December 2021: - Continued work with IQVIA to further embed 3M CRGs in the reporting and dashboard suites of their ICS Manager solution. Outcome - Still in progress - Opened negotiations with The Rotherham Hospital NHSFT to design a pilot program for the use of 3M CRGs in profiling the users of key services Outcome - Still in progress

Expected measurable benefits

Based on the proven benefits 3M United Kingdom PLC's international clients have achieved with these solutions and the anticipated benefits these solutions will may bring to the NHS, 3M United Kingdom PLC have successfully bid for and gained a place on NHS England’s Health Systems Support Framework (Lot 4 and Lot 5):- [3 paragraphs unchanged] In order to meet the NHS England’s 2022/23 priorities and operational planning, Integrated Care Systems (ICS) Boards (ICB) will need to move to more proactive joined up care wrapped around [39 words unchanged] has been put in place to provide a way for NHS organisation, Clinical Commissioning Groups (CCGs) Integrated Care Boards etc. to access support services from innovative third-party suppliers, including 3M, at [115 words unchanged] through it deliver improved insights into population heath management support Integrated Care Systems (ICSs), Boards (ICBs), Sustainability and Transformation Partnerships (STPs), and the health and social care sector in general. Based on 3M experiences introducing this product into other countries (US, Canada, Spain, Italy etc.) 3M United Kingdom PLC knows hopes that these solutions will yield benefits for Integrated Care Systems Boards in the following areas [9 paragraphs unchanged] This It is hoped this will ultimately benefit the population/individuals within those Integrated Care Systems by promoting [8 words unchanged] better care (at the point of care), and delivering both through smarter spending spending. [11 paragraphs unchanged] 1. 3M CRG will aim to deliver a patient-centric clinical model to the NHS that enables change, focussing on the total burden of illness rather than on a specific disease or service. [5 paragraphs unchanged] The benefits from the adoption of these solutions/algorithms will only become apparent after a successful pilot or sale of the solution to a UK NHS Client. The magnitude of the impact of these solutions will likely be measured at ICS scale, typically ca. 1 million individuals. 3M have engaged with a number of potential clients, as yet none of these engagements have progressed to a completed pilot or sale. There are a number of market force factors in play that have hindered these engagements, primarily linked to resource and capacity challenges (NHS data analysts, project managers etc.) and broader prioritisation issues associated with the COVID-19 pandemic. Additionally, overcoming privacy challenges faced by a number of potential clients, has meant delays whilst they spend time mitigating those concerns via stakeholder consultation (via DPIA) to enable agreement and drafting of appropriate data sharing agreements with their constituent stakeholders (primary care networks, ICBs etc). As such, continued access to the previously disseminated data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate requesting annual updates of data from NHS Digital in the future as required. Should 3M be unable to retain the data previously disseminated, 3M would be unable to assure the NHS that these solutions are tuned as accurately as possible to the NHS experience. This could slow down or prevent the adoption of these tools and the realisation of the benefits they can deliver.

Benefits reported

The disseminated dataset has achieved its first stated purpose in that 3M United Kingdom PLC launched their 3M CRG groupers in the UK in February 2020. Whilst the launched version of the 3M CRG grouper is now available, as would be expected with any complex clinical algorithms it requires continuous maintenance and revalidation as new areas of clinical data are made available, the UK NHS coding classifications and terminologies are updated and our understanding of disease progression and disease interaction improves/increases with time. For this reason it is not a data extract for a set period in time as it needs to be kept up to date with those classifications and terminologies as they themselves grow and develop with improved clinical knowledge. An agreed pilot with The Rotherham Hospital NHSFT to use 3M CRGs to profile (stratify and segment) by the burden of illness the users of their Same-Day Emergency Care (SDEC) services was signed off in March 2022. The pilot commenced in May 2022. The benefits from the adoption of these solutions/algorithms will only become apparent after a successful pilot or sale of the solution to a UK NHS Client. The magnitude of the impact of these solutions will likely be measured at ICS scale, typically ca. 1 million individuals. 3M have engaged with a number of potential Clients, as yet none of these engagements have progressed to a completed pilot or sale. There are a number of market force factors in play that have hindered these engagements, primarily linked to resource and capacity challenges (NHS data analysts, project managers etc.) and broader prioritisation issues associated with the COVID-19 pandemic. Additionally, overcoming privacy challenges faced by a number of potential clients, has meant delays whilst they spend time mitigating those concerns via stakeholder consultation (via DPIA) to enable agreement and drafting of appropriate data sharing agreements with their constituent stakeholders (primary care networks, CCGs etc). The pilot programme with the Rotherham Hospital was able to yield the following insights for the Trust- As such, further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate requesting annual updates of data from NHS Digital in the future as required. • 3M were able to successfully profile the SDEC population attending The Rotherham Hospital in 2020-2022 using 3M CRGs and highlight a number of Care Management Opportunities for the trust; specifically that lower severity single & double chronic patients account for nearly of 90% of the chronic SDEC population and that hypertension was the dominant chronic condition amongst attendees which would suggest and investment in antihypertensive therapy in the community could significantly alleviate pressure on this service. Other areas of focus would include mental health services (targeted especially at female millennials), obesity and osteoarthritis. Should 3M be unable to receive the data, 3M would be unable to assure the NHS that these solutions are tuned as accurately as possible to the NHS experience. This could slow down or prevent the adoption of these tools and the realisation of the benefits they can deliver. • A cohort of 36 individuals were identified with multiple chronic diseases that would most likely benefit from improved coordinated, person-focused care (“high priority cases for care management”). • With 3M CRGs we were able to demonstrate that the presence of a mental health condition more than doubles expected hospital days across the SDEC population and the impact of mental health increased by patient acuity; coordination with primary care and community-based services are opportunities for improvement in treating physical/mental care in combination. • Also of note to the trust was that in the broader control population (all patients) we were able to demonstrate that over 16% of all chronic patients in 2020-2021 moved into higher chronic disease statuses in 2021-2022 and over half of all health status jumpers moved from having a single chronic disease to having two chronic diseases. The value of his insight is that studying trends in the CRG severity & status jumper populations can provide opportunities for both: • Studying the impact of primary care’s management of chronic disease • Coding initiatives/coding audit and clinical data validation to make sure granularity of severity in chronic disease is being captured • The outcome of this pilot led to Rotherham Hospital NHSFT making the decision to use 3M CRGs to more accurately define Rotherham Hospital NHSFT’s SDEC cohort in terms of the current and the longitudinal burden of illness to understand if Rotherham Hospital NHSFT is seeing sicker patients now than they did 3 years ago, which disease combinations are becoming more prevalent and what services they should put in place (in association with their primary care providers) to meet that escalating need and reduce the pressure on an already stretched service in SDEC.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

3M United Kingdom PLC (3M), the largest provider of dedicated coding and [8 words unchanged] commissioners and providers), are currently working with a number of their NHS clients,(including Nottingham University Hospitals NHS Trust, East Kent Hospitals University NHS Foundation Trust and North of England Commissioning Support Unit) clients, to implement in the UK a software that has been successfully deployed [15 words unchanged] NHS England’s move towards a more Population Health Management focused health service. Those software solutions are … are: [2 paragraphs unchanged] 3M wish to retain and process the five years of pseudonymised Hospital Episode Statistics (HES) already received under the previous iteration v 5.4 of this agreement, in order to validate and refine these complex clinical algorithms and ensure they remain tuned as accurately as possible to the NHS experience. HES Critical Care Data previously received was destroyed in April 2020. During the course of this 12 month agreement 12-month Agreement, 3M will not be focusing on the All Patient Refined Diagnostic Related Groups (APR-DRG) because its it's validation and introduction to the UK will commence once Clinical Risk Groups [9 words unchanged] result of this Critical Care data is not required for validation purposes. The HES data requested is Admitted Patient Care and Outpatient attendance data. 3M will process the data obtained under this agreement Agreement in line with its it's legitimate commercial interests having interests. 3M have been awarded places on two Lots of the NHS England Health System [18 words unchanged] support of the health, care and/or wellbeing of populations within the UK: [3 paragraphs unchanged] Specifically, in regard to these articles … Although the licenced Hospital Episode Statistics (HES) data contains no field values classifiable by NHS Digital as sensitive or identifiable, 3M recognises this does contain pseudonymised data and will therefore treat it as personal and special category data under GDPR and the Data Protection Act 2018 and as such 3M UK Plc processes this special category personal data for the purposes of its legitimate interests under Articles 6(1)(f) and 9 (2)(j) of the GDPR The data controller has completed a Legitimate Interest Assessment (LIA) to document the conclusion on the lawfulness of the processing. Specifically, in regard to the three-part test: [1 paragraph unchanged] The HES data requested will be processed to generate statistical information relative to disease frequency, utilization patterns, etc. which can be used internally by 3M to test and validate the APR-DRG and CRG algorithms and their associated (3M developed) crosswalk tables between UK coding classifications, other NHS Data Dictionary items and their international equivalents. A key benefit to 3M of using a large amount of data [23 words unchanged] as possible to the NHS experience - without this volume of data, flaws and flaws, inaccuracies could go unrecorded and undermine the successful adoption of these tools and the realisation of the benefits they can deliver. 3M is working with NHS clients (including NHS England) to implement in the UK a technology that has been successfully deployed by 3M in the US for over 15 years; namely 3M All Patient Refined (APR)-Diagnostic Related Grouper (DRG)s and 3M Clinical Risk Grouper (CRG)s. The NHS will have access to enhanced data sets that will better help them better plan and analyse: o Quality and cost improvement; o Outcomes and performance measurement; o Prospective reimbursement; o Comparative profiling; o Clinical and operational redesign and improvement; o Documentation and coding improvement; o Financial and strategic planning; o Evaluation of resource needs; o Provider/Commissioner negotiation for reimbursement that matches case mix complexity [1 paragraph unchanged] Should 3M be unable to receive the data, 3M would be unable to assure the NHS that the solutions are tuned as accurately as possible to the NHS experience. This could slow down or prevent the adoption of these tools and the realisation of the benefits they can deliver. [3 paragraphs unchanged] In terms of processing the data in another more obvious or less intrusive way, 3M believe by requesting pseudonymised national data which has have no sensitive or identifiable content fields (as determined by NHS Digital) we are meeting those twin goals. [1 paragraph unchanged] A key benefit to 3M of using a large corpus of data [55 words unchanged] to achieve 3M’s purpose, the verification of these solutions cannot reasonably be achieve achieved in any other way than this. [2 paragraphs unchanged] The public understand that the NHS is changing and that new care [70 words unchanged] is risk stratification and segmentation, 3M Clinical Risk Groups (CRGs) are a clinically-based clinically based classification system for measuring a patient’s burden of illness, as opposed to [98 words unchanged] role in identifying people’s health needs and intervening appropriately to address them. [1 paragraph unchanged] 3M is the sole data controller and processor of this data, The only party processing the pseudonymised HES data from this request will be used internally by 3M United Kingdom PLC as an enabler, it will only be used for analytical purposes to validate the anglicisation and commercialisation of the 3M APR-DRG and 3M CRG software solutions. [5 paragraphs unchanged] 3M will use five years’ worth of HES data to produce and [14 words unchanged] and performance indicators and appears in-line with the expectations and requests of other applicants. previous applications. [2 paragraphs unchanged] The complex clinical algorithms involved here are designed to work on entire [65 words unchanged] 3M with evidence to support the justification for the use of young persons person's data in this request. [1 paragraph unchanged]

Processing activities

[1 paragraph unchanged] 3M United Kingdom PLC (3M) is both the data controller for this request and will be processing the data processor in this request. data. [1 paragraph unchanged] The only data transfer under this agreement will be the dissemination of the pseudonmyised, pseudonymised, non-sensitive HES data to 3M by NHS Digital. [2 paragraphs unchanged] The HES data provided through this DARS request does not contain any [17 words unchanged] data contains no field values classifiable by NHS Digital as sensitive or identifiable identifiable, 3M recognises this as special category data which constitutes personal data under [11 words unchanged] process this HES data will be made fully aware of their responsibilities with regard to regarding the General Data Protection Regulation (GDPR) and 3M’s Standard on Handling Sensitive Health Information. Awareness is facilitated and monitored via an on-going role-based training program. Processing activity activities: [9 paragraphs unchanged]

Expected output

The data from funder this request Agreement will be used internally by 3M as an enabler, it will be used for analytical purposes to anglicise, validate and commercialise the 3M software solutions. The data requested will not be provided in record level form to any third party or in any other way onward onwardly transmitted. No individuals, doctors, consultants, or patients from this data will ever be identified in 3M United Kingdom PLC products and all outputs will be aggregated with small numbers suppressed in line with the HES Analysis Guide. [1 paragraph unchanged] The output from the 3Ms 3M's processing of the pseudonymised national data will be a large number of [75 words unchanged] and verification processes applied during this project will ensure that the insights heath health care providers, planners and commissioners derive from the 3M solution solution, are accurate, actionable and can deliver genuine benefits to the health of any UK population group they are applied to. [2 paragraphs unchanged] Once validated validated, the 3M APR-DRG and 3M CRG software solutions will be available for purchase by 3M clients (NHS Trusts, CCGs or CSUs). The data requested under this agreement Agreement will not be included or in any way embedded within the 3M [30 words unchanged] incorporated into dashboards and reports all within 3M clients’ own IT environment. [14 paragraphs unchanged] Since these 3M solutions are continually evolving to improve their scope, their relevance and ultimately their value to 3M’s clients (and the populations in their care) care), 3M will require long-term access to this data for statistical, trending and [61 words unchanged] of a Certificate of Destruction. which has been approved by NHS Digital. [1 paragraph unchanged] - 3M have developed key marketing messages to the NHS, including features, advantages and benefits based on US, Spanish and Italian experiences - 3M have engaged with presented their UK compliant solutions offering to a number of ICSs, STPs and software companies involved with data aggregation and population health management with a view to establish establishing a UK proof-of-concept/pilot implementation. - Initiated -Held discussions with Director of Public Health & Executive Lead for Academic Partnerships, [8 words unchanged] Cwm Taf University Health Board to support Population Health Management (PHM) initiative. Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA (November 2021) [1 paragraph unchanged] - 3M have continued to engage with present their UK compliant solutions to ICSs, STPs and software companies. [1 paragraph unchanged] - Discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation migrated to potentially much wider project to implement 3M CRGs in NHS Wales Informatics Service (NWIS) National Data Resource Outcome: Although 3M/Frimley ICS bid made it to the final round of this procurement our bid was ultimately unsuccessful. - Discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation migrated to potentially much wider project to implement 3M CRGs in NHS Wales Informatics Service (NWIS) National Data Resource (NDR) Outcome: This project was put on hold (and remains on hold) due to changing priorities brought about by the COVID-19 pandemic. [1 paragraph unchanged] - Continued engagement with 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. - 3M have submitted a joint bid with IQVIA to support Population Health Management programme at London Procurement Partnership. Outcome: The IQVIA:3M bid was accepted and we are now part of the London Procurement Partnership Framework (March 2021) [3 paragraphs unchanged] - Continued engagement with 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. companies [1 paragraph unchanged] - Continued discussions with NWIS regarding incorporation of 3M CRGs in National Data Resource Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA (November 2021) - Continued discussions with NWIS regarding the incorporation of 3M CRGs in National Data Resource Activity to end of June 2021: - 3M have continued to present the UK compliant solutions to ICSs, STPs and software companies. - 3M are continuing the project planning and data processing tests successfully performed for proof-of-concept purposes (restricted sample dataset) with Cwm Taf Morgannwg University Health Board. Outcome: Project put on hold due to data sharing challenges within the Health Board whilst they work through these challenges by competing stakeholder consultation through a DPIA. (November 2021) - Presentation on 3M CRGs to support Population Health Management @ HIMSS-EU 2021 including the announcement of their availability in the UK - Project discussions with NHS Wales Informatics Service (NWIS) National Data Resource (NDR) put on hold (and remains on hold) due to changing priorities brought about by the COVID-19 pandemic Activity to end of September 2021: - As part of a consortia led by KMPG we responded to NHS England and Improvement’s ITT “Supporting population-based transformation and establishment of place-based partnerships HSSF21 – 079”, Outcome- 3M failed to win the tender but gained praise for the approach to population health management and these methodologies (3M CRGs and 3M APR-DRGs) - Presented 3M CRGs @ 5th NHS Data & Information Virtual Congress ca. 150 attendees, 13 leads generated which are actively being pursued Outcome: Leads were actively chased by 3M marketing team - 3M have continued to present their UK compliant solutions to ICSs, STPs and software companies. Activity to end of December 2021: - Continued work with IQVIA to further embed 3M CRGs in the reporting and dashboard suites of their ICS Manager solution. Outcome - Still in progress - Opened negotiations with The Rotherham Hospital NHSFT to design a pilot program for the use of 3M CRGs in profiling the users of key services Outcome - Still in progress

Expected measurable benefits

[3 paragraphs unchanged] 3M United Kingdom PLC The disseminated dataset will support NHS England in the areas of "Insight" and "System Optimisation Support" specifically around the areas of population health management through the introduction to the UK of the 3M All Patient Refined (APR)-Diagnostic Related Grouper (DRG)s and the 3M Clinical Risk Grouper (CRG)s. These solutions will support NHS health care providers and strategists in the areas of "Insight", "System Optimisation Support" and Outcomes measurement; primarily specifically around the areas of Population Health Management. In order to meet the vision of the Five Year Forward View (FYFV), local health systems NHS England’s 2022/23 priorities and operational planning, Integrated Care Systems (ICS) will need to move to more proactive joined up care wrapped around [141 words unchanged] made in those priority areas by comparing performance against plan. Effectively 3M need will use the pseudonymised data in the disseminated data set to qualify and verify their solutions and once qualified 3M can then optimise their position on this framework and through it deliver improved insights into population heath management to a wide range of public sector bodies supporting support Integrated Care Systems (ICSs), Sustainability and Transformation Partnerships (STPs), and the health and social care sector in general. Based on 3M experiences introducing this product into other countries (US, Canada, Spain, Italy etc.) 3M United Kingdom PLC knows that these solutions can potentially will yield benefits for UK health and social care organisations Integrated Care Systems in the following areas [9 paragraphs unchanged] This will ultimately benefit the population/individuals within those Integrated Care Systems by promoting the IHI Tripleaim, namely having healthier populations, providing better care (at the point of care), and delivering both through smarter spending By processing the disseminated dataset 3M will be able to validate and maintain UK specific versions of their 3M clinical risk groups and 3M APR-DRGs solutions. These solutions in turn, when applied to large population data set -such as will be available to Integrated Care Systems will be able to generate a uniquely clinical centric view of those populations, support the creation of clinically homogenous groups to support the introduction of improved strategic insight and more relevant and/or targeted intervention programmes for the individuals in that population. [3 paragraphs unchanged] The first release of the UK version of 3M Clinical Risk Groups was deployed in February 2020 and 3M have committed to report to NHS Digital on a quarterly basis with regard to progress on the benefits realised. The quality and performance indicators and improved clinical risk stratification / risk segmentation derived from the 3M solutions, will help Integrated Care Systems better deliver their Population Health Management programs and targets, by highlighting actionable areas for clinical and process (care management) improvement. An additional benefit for the public, is that the clinical logic of the 3M APR DRG Classification System is the basis for other 3M specialised "preventables" grouping methodologies, these will deliver proven benefits to the NHS and public in the areas of: 3M CRG will deliver a patient-centric clinical model that enables change focusing on the total burden of illness rather than on a specific disease or service. • Reduced initial admissions; • Reduced re-admissions; • Reduced A&E attendances; • Reduced Hospital Acquired Conditions The first release of the UK version of 3M Clinical Risk Groups was deployed in February 2020 and 3M have committed to report to NHS Digital on a quarterly basis regarding progress on the benefits realised. In terms of supporting a new approach to risk stratification / risk segmentation in the UK NHS, it is worth noting that: 1. 3M CRG will deliver a patient-centric clinical model to the NHS that enables change, focussing on the total burden of illness rather than on a specific disease or service. [1 paragraph unchanged] 2. 3M CRGs were developed for use in all populations and particular attention was paid to the most complex and most resource consuming patients, including paediatrics. 3. 3M CRGs provide risk adjustment for important health outcomes outcomes, making sure that comparisons are like for like 4. 3M CRGs are available as both concurrent & and prospective categorisations categorisations, with multiple levels of aggregation. 5. The clinical approach ensures the model remains stable despite changes in service costs and utilisation

Benefits reported

The disseminated dataset has achieved its first stated purpose in that 3M United Kingdom PLC launched their 3M CRG groupers on in the UK on 13th in February 2020. Whilst the launched version of the 3M CRG grouper is now available available, as would be expected with any tool further validation complex clinical algorithms it requires continuous maintenance and continuous updates to coding is necessary revalidation as new areas of clinical data are made available. available, the UK NHS coding classifications and terminologies are updated and our understanding of disease progression and disease interaction improves/increases with time. For this reason it is not a data extract for a set period in time as it needs to be kept up to date with those classifications and terminologies as they themselves grow and develop with improved clinical knowledge. As such further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate to request annual updates of data from NHS Digital in the future as required. The benefits from the adoption of these solutions/algorithms will only become apparent after a successful pilot or sale of the solution to a UK NHS Client. The magnitude of the impact of these solutions will likely be measured at ICS scale, typically ca. 1 million individuals. 3M have engaged with a number of potential Clients, as yet none of these engagements have progressed to a completed pilot or sale. There are a number of market force factors in play that have hindered these engagements, primarily linked to resource and capacity challenges (NHS data analysts, project managers etc.) and broader prioritisation issues associated with the COVID-19 pandemic. Additionally, overcoming privacy challenges faced by a number of potential clients, has meant delays whilst they spend time mitigating those concerns via stakeholder consultation (via DPIA) to enable agreement and drafting of appropriate data sharing agreements with their constituent stakeholders (primary care networks, CCGs etc). Currently there are no yielded benefits to report as 3M have yet to achieve their first contract with an NHS Integrated Care System in the UK. As such, further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate requesting annual updates of data from NHS Digital in the future as required. Should 3M be unable to receive the data, 3M would be unable to assure the NHS that these solutions are tuned as accurately as possible to the NHS experience. This could slow down or prevent the adoption of these tools and the realisation of the benefits they can deliver.

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Datasets: − Hospital Episode Statistics Critical Care (HES Critical Care)

Objective for processing

[5 paragraphs unchanged] HES Critical Care Data previously received was destroyed in April 2020. During the course of this 12 month agreement 3M will not be focusing on the All Patient Refined Diagnostic Related Groups (APR-DRG) because its validation and introduction to the UK will commence once Clinical Risk Groups (CRG) are established in the UK and as a result of this Critical Care data is not required for validation purposes. [3 paragraphs unchanged] and in line with Article 6(1)(f) and Article 9(2)(i) 9(2)(j) of the General Data Protection Regulation (GDPR). [3 paragraphs unchanged] A key benefit to 3M of using a large amount of data such as the one requested is that it allows 3M to develop, validate and modify the algorithms [34 words unchanged] of these tools and the realisation of the benefits they can deliver. [15 paragraphs unchanged] 3M have reduced the number of datasets requested on this renewal, 3M will no longer request the Critical Care data set and they will destroy those sets currently in their possession. have provided evidence of data destruction to NHS Digital.. 3M are requesting to retain and process pseudonymised data and have asked for no fields values classifiable by NHS Digital as sensitive or identifiable. [4 paragraphs unchanged] 3M will follow a process of re-validation of the live tool (ensuring it adequately reflects changes in HES data over time) thus the requirement for further to retain and process HES data to ensure this can be adequately validated is requested. 3M [30 words unchanged] reflected change in the data due to regulations and updated national guidance.

Processing activities

[7 paragraphs unchanged] Processing activity (High Level) [9 paragraphs unchanged]

Expected output

[21 paragraphs unchanged] Since these 3M solutions are continually evolving to improve their scope, their [41 words unchanged] data - by way of example, once the 2017/18 annual refresh data has been was received and processed 3M would delete have deleted the 2012/13 HES data in accordance with NHS Digital guidance and 3M will provide have provided confirmation of the secure and permanent destruction to NHS Digital in the form of a Certificate of Destruction. which has been approved by NHS Digital. Activity to end of July 2020: - 3M have developed key messages to the NHS, including features, advantages and benefits based on US, Spanish and Italian experiences - 3M have engaged with ICSs, STPs and software companies involved with data aggregation and population health management to establish UK proof-of-concept/pilot implementation. - Initiated discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation regarding pilot implementation at Cwm Taf University Health Board to support Population Health Management (PHM) initiative. Activity to end of September 2020: - 3M have continued to engage with ICSs, STPs and software companies. - 3M have submitted joint bid with Frimley ICS to NHS England, NHS Improvement and SBRI to reduce ED demand by prevention using clinical and modifiable risk stratification - Discussions with Director of Public Health & Executive Lead for Academic Partnerships, Research, Development and Innovation migrated to potentially much wider project to implement 3M CRGs in NHS Wales Informatics Service (NWIS) National Data Resource Activity to end of December 2020: - Continued engagement with ICSs, STPs and software companies. - 3M have submitted joint bid with IQVIA to support Population Health Management programme at London Procurement Partnership. - 3M have continued discussions with NWIS regarding incorporation of 3M CRGs in National Data Resource Activity to end of March 2021: - 3M successfully gained a place on the London Procurement Partnership framework via joint bid with IQVIA whereby their ICS Manager solution will utilise the 3M CRG Risk Stratification/Risk Segmentation methodology. - Continued engagement with ICSs, STPs and software companies. - Cwm Taf Morgannwg University Health Board have entered into an agreement with 3M around improving health informatics part of that agreement is to launch a pilot programme for Population Health Management using the 3M CRG Risk Stratification/Risk Segmentation methodology. - Continued discussions with NWIS regarding incorporation of 3M CRGs in National Data Resource

Expected measurable benefits

[5 paragraphs unchanged] Based on 3M experiences introducing this product into other countries (US, Canada, Spain, Italy etc.) 3M United Kingdom PLC knows that these solutions can potentially yield benefits for UK health and social care organisations in the following areas • Quality and cost improvement; • Outcomes and performance measurement; • Prospective reimbursement; • Comparative profiling; • Clinical and operational redesign and improvement; • Documentation and coding improvement; • Financial and strategic planning; • Evaluation of resource needs; • Provider/Commissioner negotiation for reimbursement that matches case mix complexity [3 paragraphs unchanged] The first release of the UK version of 3M Clinical Risk Groups is now was deployed in February 2020 and 3M will have committed to report to NHS Digital on a quarterly basis with regard to progress on the benefits. Due to unforeseen circumstances this is later than the original planned release date of May 2019; the reason for this delay is entirely down to availability of suitably qualified resources. benefits realised. 3M CRG will deliver a patient-centric clinical model that enables change focusing on the total burden of illness rather than on a specific disease or service. This categorical approach to patient classification provides clinicians with actionable data. 3M CRGs were developed for use in all populations and particular attention was paid to the most complex and most resource consuming patients, including paediatrics. 3M CRGs provide risk adjustment for important health outcomes making sure that comparisons are like for like 3M CRGs are available as both concurrent & prospective categorisations with multiple levels of aggregation. The clinical approach ensures the model remains stable despite changes in service costs and utilisation

Benefits reported

3M United Kingdom PLC launched their 3M APR-DRG and 3M CRG groupers on the UK on 13th February 2020). 2020. Whilst the launched version of the 3M APR-DRG and 3M CRG grouper is now available as with any tool further validation and continuous updates to coding is necessary as new areas of clinical data are made available. As such further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate to continue to request annual updates of data from NHS Digital. Based on 3M experiences introducing this product into other countries (US, Canada, Spain, Italy etc.) 3M United Kingdom PLC knows that these solutions can yield benefits for UK health and social care organisations , As such further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate to request annual updates of data from NHS Digital in the future as required. • Quality and cost improvement; Currently there are no yielded benefits to report as 3M have yet to achieve their first contract with an NHS Integrated Care System in the UK. • Outcomes and performance measurement; • Prospective reimbursement; • Comparative profiling; • Clinical and operational redesign and improvement; • Documentation and coding improvement; • Financial and strategic planning; • Evaluation of resource needs; • Provider/Commissioner negotiation for reimbursement that matches case mix complexity In terms for specific examples of where 3M CRGs (for example) have played a significant role in driving down costs and improving care the following examples may be useful: United States: • Quality outcomes and total cost-of-care management for managed care and accountable care organisations (ACOs) in state Medicaid programs, such as Texas and New York • Outcomes-based payment programs used by commercial payers and regional/national health plans, including many Blue Cross® Blue Shield® organisations across America • Public performance reporting and all payer claims database analysis by state agencies, including the Utah Department of Health and the Texas Health and Human Services Commission • Population health and episodes-of-care analyses for the Medicare Payment Advisory Commission (MedPAC) • Comparisons of quality and utilisation in special needs delivery programs, such as HIV, mental health and substance abuse Spain: • CRGSs offer insight into the current and planned locations of primary care centres based on the geographic distribution of the chronic population within a given region. Areas where many chronic people live benefit from more primary physicians and resources. • Identify patients for specific interventions. CRGs are used in Spain to assign nurses to visit some frequent readmissions chronic population (e.g. Diabetes + COPD) each 10 days, decreasing the readmissions rate in those on the programme to half. • offer insight into the pharmacy costs for “high cost” patients. GPs have sight of the real cost of each patient and of the average cost of that type of patient (i.e. the ones with the same CRG) across the region. This information can be used to identify outliers of poor or exceptional performance.

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Objective for processing

3M United Kingdom PLC (3M), the largest provider of dedicated coding and grouping software solutions to the NHS, NHS (covering both commissioners and providers), are currently working with a number of their NHS clients,(including Nottingham University [26 words unchanged] been successfully deployed by 3M in the US for over 15 years; namely 3M All Patient Refined (APR)-Diagnostic Related Grouper (DRG)s and 3M Clinical Risk Grouper (CRG)s. this software can significantly accelerate the NHS England’s move towards a more Population Health Management focused health service. 3M will use longitudinal national data from DARS to soak test and further refine a number of complex clinical algorithms they have developed. The purpose of these algorithms is to support the NHS in developing effective population health management programs by providing an accurate clinically-based risk stratification toolkit. The algorithms will also produce quality and performance indicators which will help the NHS better perform its duties by highlighting areas for clinical and process improvement. Those software solutions are … The 3M APR DRG software uses standard patient discharge information to classify patients into clinically meaningful groups, adjusting the data for severity of illness and risk of mortality for any patient population in acute care settings. The software aligns the care provided in the hospital with costs and will help NHS clients better understand their populations’ health across the care continuum. 3M CRG software uses diagnosis and procedure codes, pharmaceutical data and functional/mental health status to assign individuals to severity-adjusted homogeneous groups, helping NHS clients anticipate the amount and type of care they will use in the future. • The 3M™ All Patient Refined DRGs (APR DRG) are a system of classifying patients by their reason of admission, severity of illness (SoI), and risk of mortality (RoM). They are used widely used throughout the United States for hospital management, public quality reporting, risk adjustment and the identification of potentially preventable events (e.g. unnecessary re-admissions). The 3M CRG classification system describes the health status and burden of illness of individuals in an identified population. It is a categorical clinical model that classifies each member of the population based on his or her burden of medical conditions, assigning each individual to a single mutually exclusive risk category. • The 3M™ Clinical Risk Groups (CRGs) are a system for classifying patients based on their total burden of illness. Each member of a given population is assigned into a single, mutually exclusive risk category derived from a clinical understanding of their chronic disease burden and the interaction between diseases and care settings. They are used in over 40 US States to give deeper insight into the clinical complexity of their populations. 3M CRGs are used for stratifying populations, risk adjustment, predicting healthcare utilisation and cost, tracking health outcomes, and analysing the health of populations. For healthcare providers and planners, failure to include adequate risk adjustment in their population health management modelling can result in the inequitable distribution of financial and other resources which will ultimately affect (negatively) the quality of care given to those individuals most in need of it. 3M wish to process five years of pseudonymised Hospital Episode Statistics (HES) in order to validate and refine these complex clinical algorithms and ensure they remain tuned as accurately as possible to the NHS experience. Additional quality and performance indicators derived from these 3M software solutions will also help the NHS better perform its duties by highlighting actionable areas for clinical and process improvement; improved data leads to improved decisions. The HES data requested is Admitted Patient Care and Outpatient attendance data. 3M will process the data obtained under this agreement in line with its legitimate commercial interests having been awarded places on two Lots of the NHS England Health System Support Framework (HSSF) which may be accessed by public sector bodies that are engaged in the management and/or support of the health, care and/or wellbeing of populations within the UK: The pseudonymised data from this request will be used (internally) by 3M to anglicise both these software solutions, specifically by supporting the development of crosswalk tables and algorithms between UK coding classifications (and other NHS Data Dictionary items) and their international equivalents. The output of the data processing effort will be software solutions tailored to support the dozen or so NHS clients who have already expressed interest in engaging 3M for use of the APR DRG and 3M CRG software. • Lot 4 - Informatics, analytics, digital tools to support system planning, assurance and evaluation 3M were successful in their bid to join the NHS England Health System Support Framework, this project will enable 3M to support NHS England in the areas of "Insight" and "System Optimisation Support" specifically around the areas of population health management through the introduction to the UK of the 3M APR-DRGs and the 3M CRGs software. • Lot 5 - Informatics, analytics, digital tools to support care coordination, risk stratification and decision support. See Lot 4 and 5 on the following webpage for confirmation: https://www.england.nhs.uk/hssf/supplier-lists/ and in line with Article 6(1)(f) and Article 9(2)(i) of the General Data Protection Regulation (GDPR). 3M wishes to process the data obtained under this agreement in line with its legitimate commercial interests to customize a software solution to the UK market in which there is demonstrable demand from NHS clients. The volume and breadth of this data is necessary to this legitimate interest; there is no way for 3M to reasonably achieve the same result without access to this data. Tuning software solutions of the nature offered by 3M requires such data to minimize data flaws and inaccuracies in the underlying software and algorithms. Specifically, in regard to these articles … • Purpose Test The HES data requested will be processed to generate statistical information relative to disease frequency, utilization patterns, etc. which can be used internally by 3M to validate the APR-DRG and CRG algorithms and their associated (3M developed) crosswalk tables between UK coding classifications, other NHS Data Dictionary items and their international equivalents. A key benefit to 3M of using a large amount of data such as the one requested is that it allows 3M to develop, validate and modify the algorithms within 3M groupers to make sure they are tuned as accurately as possible to the NHS experience - without this volume of data, flaws and inaccuracies could go unrecorded and undermine the successful adoption of these tools and the realisation of the benefits they can deliver. The key indicators derived from the 3M solution (Clinical Risk Category, Health Status, Risk of Mortality, Severity of Illness etc.) will help the NHS better perform its duties by highlighting actionable areas for clinical and process improvement; “improved data leads to improved decisions” • Necessity Test The processing of this data is necessary to achieve 3M’s purpose, the verification of these algorithms cannot reasonably be achieved in any other way than this and 3M are working only with pseudonymised data which has no sensitive content. The data requested needs to be pseudonymised so that a longitudinal record of a patient can be created, clinical risk algorithms need to have sight and understanding of disease progression and the level and nature of disease co-morbidities to accurately assign risk categories. A smaller data sample would not provide as complete a picture of the disease burden across the country as the data we have requested, and a smaller data sample would not offer assurance to our end-users (the NHS) that 3M’s solutions are tuned as accurately as possible to the NHS experience. In terms of processing the data in another more obvious or less intrusive way, 3M believe by requesting pseudonymised national data which has no sensitive or identifiable content fields (as determined by NHS Digital) we are meeting those twin goals. • Balancing Test A key benefit to 3M of using a large corpus of data such as the one requested is that it allows 3M to develop, validate and modify the algorithms to make sure they are tuned as accurately as possible to the NHS experience and fully meet 3M’s commitments under the NHS England Health Systems Support Framework. Consequently, the processing of these volumes of HES data is necessary to achieve 3M’s purpose, the verification of these solutions cannot reasonably be achieve in any other way than this. This HES extracted data comprises a longitudinal record of all admissions and outpatient appointments at NHS hospitals in England as such it will include the records of children and vulnerable people. 3M recognises it as special category data and 3M have carried out a data protection impact assessment (DPIA) and it is worth stating at this point that 3M have worked in collaboration with the US Children’s Hospital Association to ensure these algorithms address the needs of paediatric populations. Additionally, the HES data 3M will use is not obtained directly from patients but from hospital provider systems via the Secondary Uses Service (SUS) and the 3M extract includes no field values classifiable by NHS Digital as Sensitive or Identifiable. The public understand that the NHS is changing and that new care models are being developed to improve population health and, in addition, that the NHS has a direct role to play in identifying people’s health needs and intervening appropriately to address them. There is an understanding that data about people’s health needs to be used to identify groups within a given population that would benefit from different types of support. A foundational building block for the implementation of population health management is risk stratification and segmentation, 3M Clinical Risk Groups (CRGs) are a clinically-based classification system for measuring a patient’s burden of illness, as opposed to regressive statistical systems (which are more typical of the wider European market at present). Their purpose is to give a deeper insight into the clinical complexity of a given population, greater insight meaning that 3M can distinguish between patients who may share the same diagnosis but at the same time differ widely in their severity of illness, overall health status and ultimately their projected use of healthcare resources etc. By processing these volumes of HES data to verify the anglicisation of these solutions 3M will be able to directly supports the NHS both from a commissioning and provider role in identifying people’s health needs and intervening appropriately to address them. As well as supporting intervention 3M CRGs and APR-DRGs can be used for stratifying populations, risk adjustment, predicting healthcare utilisation and cost, tracking health outcomes, and analysing the health of populations. For healthcare providers and planners, failure to include adequate risk adjustment in their population health management modelling can result in the inequitable distribution of financial and other resources which will ultimately affect (negatively) the quality of care given to those individuals most in need of it. 3M is the sole controller and processor of this data, The pseudonymised HES data from this request will be used internally by 3M United Kingdom PLC as an enabler, it will be used for analytical purposes to validate the anglicisation and commercialisation of the 3M APR-DRG and 3M CRG software solutions. There are no further funders or commissioners involved in this project that have not been mentioned in this agreement. The data requested is an enabler, it will not be included or in any way embedded within the resultant software solutions and will not be provided in record level form to any third party or similarly onward transmitted. Data Minimisation: 3M have reduced the number of datasets requested on this renewal, 3M will no longer request the Critical Care data set and they will destroy those sets currently in their possession. 3M are requesting pseudonymised data and have asked for no fields values classifiable by NHS Digital as sensitive or identifiable. 3M will use five years’ worth of HES data to produce and perform the necessary validation. This will allow sufficient historic comparison of previous years quality and performance indicators and appears in-line with the expectations and requests of other applicants. 3M have made this data request in order to validate and refine a number of these complex clinical algorithms and ensure they remain tuned as accurately as possible to the NHS experience The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. Clinical risk algorithms need to have sight and understanding of disease progression and the level and nature of disease co-morbidities to accurately assign risk categories. Additionally the 3M software is continually being developed and refined by 3M's clinical experts, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions – restricting the test data by geographic, demographic or clinical factors would severely undermine that validation process. The complex clinical algorithms involved here are designed to work on entire populations as with the filtering question to restrict the test data by episode type would similarly undermine that validation process. With specific regard to neonate and child records the 3M algorithms has been developed with input from the National Association of Children's Hospitals and Related Institutions (NACHRI) and is particularly good in measuring the illness burden of medically complex children. As such this research provides 3M with evidence to support the justification for the use of young persons data in this request. 3M will follow a process of re-validation of the live tool (ensuring it adequately reflects changes in HES data over time) thus the requirement for further HES data to ensure this can be adequately validated is requested. 3M will take current data and validate the 3M CRG clinical model that was built. Having recent data allows 3M to validate the alignment of the 3M CRG Methodology with the reflected change in the data due to regulations and updated national guidance.

Processing activities

The HES data from this request will be in pseudonymised form and never linked with other datasets which could allow re-identification of HES data. The data will remain in a secure environment within 3M's UK IT enterprise, it will not be accessed/processed by any other parties and will not be shipped as part of any solutions developed by 3M. All individuals accessing the data are employees of 3M United Kingdom PLC; no employees of any 3M United Kingdom PLC affiliates based outside of the UK will have access to this data. The data provided for this project will only be processed in the UK using 3M proprietary data processing software. This software will analyse and cleanse the data, convert the codes contained to their US equivalents using 3M developed crosswalk tables and associated algorithms. The crosswalked data will then be processed through a number of 3M proprietary/internal groupers (essentially the UK modified components of the 3M APR-DRG and 3M CRG software) which will output quality and performance indicators, flags and values into various and multiple categorical databases for comparison with international norms and other comparative output criteria (national statistics etc.) by 3M clinical data experts. This is an iterative process and will be repeated by 3M until the crosswalk tables and algorithms are deemed as accurate as possible for the NHS experience. 3M will use five years’ worth of HES data to produce the outputs required. This is to allow sufficient historic comparison of previous years quality and performance indicators. By way of example, once the 2017/18 annual refresh data has been received and processed 3M will delete the 2012/13 HES data. The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. The 3M software is continually being developed and refined by 3M's clinical and technical teams, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions. [1 paragraph unchanged] 3M United Kingdom PLC (3M) is both the data controller and the data processor in this request. There will be no flow of data into NHS Digital from 3M. The only data transfer under this agreement will be the dissemination of the pseudonmyised, non-sensitive HES data to 3M by NHS Digital. The HES data requested is classified by NHS Digital as “Anonymised/Pseudonymised, Non-sensitive” and will never be linked with other datasets which could allow re-identification. The data will remain on a dedicated secure environment within 3M's UK IT enterprise, it will only be accessed by a restricted number of substantive employees of 3M and will never be accessed/processed by any other parties or shipped as part of any solutions developed by 3M. All employees accessing the data must be UK based and belong to a specific security group and in order to join this group users must complete a questionnaire and provide a business justification for their access. Security administrators will review every request, assess the justification and approve the request if valid. The HES data provided through this DARS request does not contain any PID records\fields such as patient name, addresses, date of birth or NHS number. Although this pseudonymised HES data contains no field values classifiable by NHS Digital as sensitive or identifiable 3M recognises this as special category data which constitutes personal data under GDPR and the Data Protection Act 2018. All employees authorised to process this HES data will be made fully aware of their responsibilities with regard to the General Data Protection Regulation (GDPR) and 3M’s Standard on Handling Sensitive Health Information. Awareness is facilitated and monitored via an on-going role-based training program. Processing activity (High Level) • The original pseudonymised HES data will be downloaded to a nominated folder on the secure server. • The data for the year in focus will be extracted. • Specialist software routines will cleanse that data and convert UK specific data items to their international equivalents using 3M developed crosswalk tables and algorithms • The converted data will then be formatted and processed through the two software solutions being validated: 3M™ All Patient Refined DRGs (APR DRG) and 3M™ Clinical Risk Groups (CRGs) • The very many output fields from these solutions (quality and performance indicators, flags and values) will be loaded into a database for subsequent analysis • Reports will be run in that database environment that will compare and contrast combinations of the output data generated with international patterns of distribution and other comparative output criteria (national statistics on chronic diseases etc.). • This iterative process will be repeated until the crosswalk tables and algorithms are deemed as accurate as possible for the NHS experience. 3M will use five years’ worth of HES data to produce and perform the necessary validation. This is to allow sufficient historic comparison of previous years quality and performance indicators. The volume of data requested, and its longitudinal breadth is vital for 3M to develop, validate and modify the algorithms within the software to ensure it is tuned as accurately as possible to the NHS experience. The 3M software is continually being developed and refined by 3M's clinical and technical teams, new versions are issued on a regular basis and a longitudinal view of national data is required by 3M to support the regression testing of these new versions.

Expected output

The pseudonymised data from this request will be used internally by 3M United Kingdom PLC as an enabler, it will be used for analytical purposes to anglicise anglicise, validate and commercialise the 3M APR-DRG & 3M CRG software solutions. The data requested will not be included or in any way embedded within the resultant software solutions [1 paragraph unchanged] 3M expect to be able to make a first release of both solutions available to those NHS that have expressed an interest in May 2019 Validation: The output from the 3Ms processing of the pseudonymised national data will be a large number of software generated clinical indictors, indicators, flags and values. The relative frequency, utilization and patterns of relationship between these indicators is at the core of 3M’s validation process. These clinical indictors, indicators, flags and values will be checked internally by 3M United Kingdom PLC [65 words unchanged] to the health of any UK population group they are applied to. 3M’s validation will focus particularly on the accuracy of the 3M generated crosswalk tables and associated algorithms which have been developed to support the use of UK generated clinical information (including clinical coding classifications and other NHS Data Dictionary items). Validation Output from this process will typically be based on aggregated attributes contain only data that is aggregated, with small numbers suppressed, in line with the HES Analysis Guide, for example the average number prevalence of diagnosis and interventions by APR-DRGs, CRGs, Chronic Disease Categories etc. In addition the output of this processing will 3M generate chronic disease indicators would be iteratively validated by 3M against compared with international benchmarks and publicly available UK national statistics (e.g. national incidence of Diabetes, COPD, Ischaemic Heart Disease etc.). and aggregated comparisons would be made with other clinical, productivity or quality indicators such as average length of stay or average number of interventions by APR-DRG, CRG, Chronic Disease Category etc. The aggregated information only will be used beside the 3M generated content and surfaced with the product outputs for the purposes of benchmarks or productivity/quality indicators for 3M United Kingdom PLC's clients (providers and commissioners). Any outputs will contain only data that is aggregated, with small numbers suppressed, in line with the HES Analysis Guide. Client Implementation: Since these 3M solutions are continually evolving to improve their scope, their relevance and ultimately their value to 3M’s clients (and the populations in their care) 3M will require long-term access to this data for statistical, trending and longitudinal validation purposes. It will be necessary to hold a rolling corpus of 5 years data i.e. as a new annual dataset becomes available 3M would add that to the corpus and destroy the oldest annual dataset within that same corpus. Once validated the 3M APR-DRG and 3M CRG software solutions will be available for purchase by 3M clients (NHS Trusts, CCGs or CSUs). The data requested under this agreement will not be included or in any way embedded within the 3M software deliverables. The 3M software solutions will be deployed by 3M clients, consume 3M clients’ own information and the clinical indictors, flags and values generated by 3M solutions will be incorporated into dashboards and reports all within 3M clients’ own IT environment. Key outputs from the software: 3M™ Clinical Risk Groups (CRG) system (includes but is not limited to) • CRG – a code that classifies each individual processed by disease burden, the severity level of that burden and their overall health status (current and prospective). • ACRGs – aggregated variants of the CRG (5 levels) (current and prospective). • MDCs – a list of Major Diagnostic Categories assigned to each individual processed • EDCs – Episode Disease Categories • EPCs – Episode Procedure Categories 3M™ All Patient Refined DRGs (APR DRG) system (includes but is not limited to) • APR-DRG – a code that classifies every episode of care delivered to an individual • SOI – Severity of Illness indicator for that episode of care • ROM – Risk of Mortality indicator for that episode of care • PPA – Potentially Preventable Admissions indicator • PPR – Potentially Preventable Re-admissions indicator • PPC – Potentially Preventable Complications indicator Since these 3M solutions are continually evolving to improve their scope, their relevance and ultimately their value to 3M’s clients (and the populations in their care) 3M will require long-term access to this data for statistical, trending and longitudinal validation purposes. It will be necessary to hold a rolling body of 5 years data - by way of example, once the 2017/18 annual refresh data has been received and processed 3M would delete the 2012/13 HES data in accordance with NHS Digital guidance and 3M will provide confirmation of the secure and permanent destruction to NHS Digital in the form of a Certificate of Destruction.

Expected measurable benefits

3M United Kingdom PLC (3M) are developing a UK based tool for the benefit of the NHS and the wider UK health and social care market. Based on the proven benefits 3M United Kingdom PLC's international clients have achieved with these solutions and the anticipated benefits these solutions will bring to the NHS, 3M United Kingdom PLC have successfully bid for and gained a place on NHS England’s Health Systems Support Framework (Lot 4 and Lot 5):- Based on the proven benefits 3M United Kingdom PLC's international clients have achieved with these solutions and the anticipated benefits these solutions can bring to the NHS, 3M United Kingdom PLC have successfully bid for and gained a place on NHS England’s Health Systems Support Framework (Lot 4 and Lot 5):- [3 paragraphs unchanged] See Lot 4 and 5 on the following webpage for confirmation: https://www.england.nhs.uk/hssf/supplier-lists/ [1 paragraph unchanged] With specific reference to the expected measurable benefits these solutions can bring to the NHS; they are genuine and can be support by numerous academic papers, case studies, white-papers; furthermore the suppliers on NHS England’s Health Systems Support Framework have passed rigorous selection criteria to ensure their products are of a high quality, their prices fair and their financial position stable [3 paragraphs unchanged] 3M expect to be able to make their first release of both solutions available to those NHS organisations that have expressed an interest in May 2019 The first release of the UK version of 3M Clinical Risk Groups is now deployed 3M will report to NHS Digital on a quarterly basis progress on the benefits. Due to unforeseen circumstances this is later than the original planned release date of May 2019; the reason for this delay is entirely down to availability of suitably qualified resources.

Benefits reported

3M United Kingdom PLC have yet to commercially launch their 3M APR-DRG and 3M CRG groupers in the UK - the UK pilot programs are awaiting completion of the on-going verification/anglicisation work. 3M United Kingdom PLC launched their 3M APR-DRG and 3M CRG groupers on the UK on 13th February 2020). Whilst the launched version of the 3M APR-DRG and 3M CRG grouper is now available as with any tool further validation and continuous updates to coding is necessary as new areas of clinical data are made available. As such further data is still required to continue the ongoing building and validation of the product in addition to being able to amend the product with any data coding changes. 3M anticipate to continue to request annual updates of data from NHS Digital. However based Based on the 3M experiences in the US, introducing this product into other countries (US, Canada, Spain, Italy etc.) 3M United Kingdom PLC knows that these solutions can yield benefits in the areas of: for UK health and social care organisations , [10 paragraphs unchanged] United States: [1 paragraph unchanged] • Outcomes-based payment programs used by commercial payers and regional/national health plans, including many Blue Cross® Blue Shield® organisations across America [3 paragraphs unchanged] Spain: • CRGSs offer insight into the current and planned locations of primary care centres based on the geographic distribution of the chronic population within a given region. Areas where many chronic people live benefit from more primary physicians and resources. • Identify patients for specific interventions. CRGs are used in Spain to assign nurses to visit some frequent readmissions chronic population (e.g. Diabetes + COPD) each 10 days, decreasing the readmissions rate in those on the programme to half. • offer insight into the pharmacy costs for “high cost” patients. GPs have sight of the real cost of each patient and of the average cost of that type of patient (i.e. the ones with the same CRG) across the region. This information can be used to identify outliers of poor or exceptional performance.