“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Hampshire Clinical Repository Hugh Sanderson Head of Clinical Information Development

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” What is it What does it look like Clinical feeds/ Date entry Security and consent Database Potential for Clinical Indicators Overview

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” A browsable combined patient record with extracts of: GP record Hospital records Additional record fields for: Single assessment process Cancer data Occupational Therapy Linked pseudonymised database for analysis What is it?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Clinical Record Anonymised database CDR Patient Index 200+ GP practices Winchester Portsmouth Southampton North Hants Trusts PAS, Pharmacy, Pathology, Radiology, Cancer Databases, Clinical letters D a i l y / R e a l t i m e f e e d s A n o n y m i s e d A n a l y s i s Exeter Data entry screens Clinical Access

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Based on experience of an ERDIP pilot study in Central Hampshire: –BMJ April 2004 Interim solution to exploit legacy systems which will be replaced when NPfIT provides similar functionality Why are we doing it?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Better emergency care in A&E, Out of Hours Service, drop in centres Better coordinated care between hospital, GP, Community and Social Services Better information for planning and monitoring and audit based on the whole patient journey. Benefits

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Single assessment process Occupational Therapy Cancer MDT records Can be partially completed and updated later Drop down menus and date selection Direct data entry

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

PHT MAU PHT Outpatient Appt. (inc IOW) PHT QA CT Scan PHT QA Fluoroscopy PHT QA Medical Physics PHT QA MRI Scan PHT QA Nuclear Medicine PHT QA Ultra Sound PHT QA X-ray PHT RHH Biochem/ Haematology PHT RHH Blood Transfusion PHT RHH Histology PHT RHH Microbiology PHT RHH MRI Scan PHT RHH Ultrasound PHT RHHX-Ray SUHT Biochemistry SUHT Correspondence SUHT Haematology SUHT Histopathology SUHT Immunology SUHT Medical Microbiology SUHT Virology WEHT Allergies/alerts WEHT A&E discharge WEHT IP Discharge WEHT OP appointment WEHT IP prescribing WEHT wait listing Hospital Feeds

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Clinical Repository Advisory Group GPs Acute Hospital / Primary Care Trusts Mental Health Trust Patients/ Carers LMC Advise on security arrangements and data analysis requests and information to the community. Information Governance

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Explicit consent required each time before record can be viewed unless previously agreed ( = Opt in) Public information campaign through leaflet distribution Patients can opt out of Common Health Record Staff role determines type of access Read codes only downloaded from GP record Audit trail to record who has looked at which record and when Patients have the right to see the audit trail and their record. Pseudonymised data analysis Consent model

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Samples from the Central Hampshire pilot Early results of analysis from Hampshire Data Analysis

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Post operative wound infections Post op infection rate using hospital data = 0.4% Post op infection rate using hospital and GP data = 3.2%

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Chronic disease Monitoring Of 92 patients with diabetes: –1,987 lab results for 49 patients –511 by GP, 1,476 by consultants, (225 in OP dept ) –40 HBA1 tests on 34 patients –27 done by GP, 13 in Outpatients –57% of results were above normal limits

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

BP ControlMean (months)Patients No H/T ,861 Good ,940 Poor ,546 Total ,347 76% of those with poor control had a BP in 2005 or more recently, 89% of those with good control did. BP Control

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Linked primary and secondary care records. Records of events ( OP, A&E, Admissions, Discharges, procedures, radiology, etc) Numerical values for laboratory/ clinical measures. Diagnosis and procedure codes Feeds from existing clinical data systems and data set submissions. Value for clinical Indicators

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Coverage of all practices/ trusts/ independent providers. Data quality ( especially GP records) Comparability of lab results. Security, confidentiality and Information governance. Distributed analysis service Ongoing Issues