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Use of information technology in the processing and analysis of health services information and in support of the provision of health care

Applications: Use of information technology in the processing and analysis of health services information and in support of the provision of health care

Identifying patients to the system: The Exeter system records every registration of a patient to a GP practice. Data includes patient's full name and address, including postcode, date of birth, sex, date of registration, place of birth (free text), and some data on data of entry to the UK. Data is partition so that PCTs are given access to their resident patients, plus aggregate data for their registered patients who live outside the PCT. PCTs can set up mutual exchange arrangements to enable each other to have full details.  The Exeter system was originally intended to enable GPs to be paid, when the main determinant of the pay was a capitation fee.

Derived from the NHS Central Register, in theory a patient can only be recorded once. In practice, an estimated 5.6% inflation is encountered.

GP activity: GP systems vary, but as most GPs are now on contracts where their remuneration depends on recording activity performed for patients, their current systems reflect this. The systems record appointments, tests requested (with results when these are available), physiological measurements, prescriptions and referrals. In general, without special arrangements, GPs' data at patient level is not available to PCTs, but nationally analysed data in terms of the Quality and Outcomes Framework (QOF) contract data is available at practice level. The QOF itemises those data items thought by the Department of health to be sufficiently important to affect GP's fees. These include blood pressure measurement, smoking, body mass index, diabetic lab results, proportions of children immunised, and various other items that may change from year to year.

Getting patients into the secondary care (hospital) system: A main plank of the current Connecting for Health strategy is 'Choose and Book', intended to allow patients choice of potential hospital providers and to book appointments directly on line rather than relying on the hospital to prioritise and allocate a slot. This is in partial operation (as at June 2008).

Hospital Activity:

  1. Accident and Emergency:  A&E systems track patients from first arrival through encounters with NHS staff, through diagnosis and (possibly) intervention to outcome (discharge, admission etc).  A&E systems have risen in prominence since major political emphasis was placed on quick attention and maximum time spent in A&E. Diagnostic codes are limited to one or two per visit, so underlying issue such as substance abuse may be under-counted.
  2. Patient Administration Systems (PAS): the hospital's master system for recording what happens to their patients. Administers outpatient clinics, capacity, list sizes, appointments & attendance, level of medical staff per appointment. Administers Elective Admission Lists (waiting lists), recording date on list, urgency, intended treatment and management, specialty, consultant, any periods of suspension. Tracks admitted patients through hospital, including specialty, consultant, dates, intended management, ward admissions and transfers, discharges; after discharge data is clinically coded for diagnostics (using ICD10 codes) and surgical interventions (using OPCS4 codes), and assigned an HRG (Healthcare Resource Group) for payment. Extracts from PAS admitted patients data and (recently) outpatients data go to the national Secondary User Service, where the data is partitioned for registered and resident PCT, and certain field are taken off to the Hospital Episode Statistics (HES) database, which is used by the Department of Health for NHS planning purposes. These partitioned files enable PCTs to analyse their patient's care wherever they are treated within the NHS, and allow for benchmarking (using appropriate age/sex standardisation) against national or selected counterpart organisations.
  3. Clinical Audit/Research Systems: can be part of a central hospital database or locally run by a department, or as part of a national audit process. These record clinical aspects in more detail than PAS. The National Service Framework for Cardiovascular disease is recorded on a national standard system, MINAP.
  4. Laboratory Systems: These record requests for and results of laboratory tests.

Community Health Care: Systems vary, but PCTs run systems to manage children's health (recording immunisation, health visitors, birth weights etc) and some para-medical activity such as physiotherapy & podiatry, also sexual health and teenage pregnancy data.

Genito-Urinary Clinics: record patient data at catchment level, and are not permitted to report at other levels. This data is subject to certain extra statutory protection.

Public Health

Vital Statistics: Public Health departments are allowed full details of the births and death registration relevant to their areas. Although this data is in the public domain (via the public registry office) users are required to treat it as personal data that should not be disclosed.

Geographic Information Systems (GIS): Most NHS data has geographic data indirectly attached, usually as the postcode of the patient. The Office of National Statistics, working with the Post Office, produces the NHS Postcodes file, which includes mapping coordinates for the centroid of each postcode polygon to the nearest 100 metres, and for a fee a version accurate to 1 metre can be obtained. The file is updated four time per year. This file also allocates the postcode to every possible level, current and obsolete, of  administrative geography, including PCT, Local Authority, ward, Super Output Area, and others. In combination with software that is designed to display maps this data can be presented in ways that cast a great deal of light on the health issues faced by a PCT,or SHA.

© M Goodyear 2008