Transcript Document
Mental Health Information NHS Trust Forum
Thursday 28th January 2010
Introduction
•Latest release and use of MHMDS
•MHMDS Approvals – where we are
•New datasets
–IAPT
–Community, Maternity, Child Health, CAMHS
•ICs new role
Plan (Hope)
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Approvals – soon
Only issue – what goes to commissioners
ISN – February / March
Q4P / Q3R submission as normal
Annual submission as normal
No Q4R submission
Q1P submission – v4 IDB
Fall back – no Q1P (but not agreed with
DH or anyone else) and mapping
Payment by Results
• V3.5 – any time
• HoNOS65+ any time
(if you’re on the list)
• Guidance
Transitions
And
Algorithms
Product
Review
Group
Costing
Outcomes
Mental
Health
Clustering
Tool
Clinical:
LD
Secure
IAPT
Summary of changes
• Clusters:
– Can flow - now
– Should flow – from April 2011
– Must flow – by December 2011
• New data items
– Can flow – Q1, 2011/12
– Should flow – as soon as possible
– Must flow – April 2012/13
Tables removed
• Community episode of Community Psychiatric Nursing
• Inpatient Episode (IPEP replaced by INPATEP and
PROVSPELL)
• Professional Staff Episode
• Care Co-ordinator
• Responsible Clinician
• CPN Contact
• Consultant Outpatient Attendance
• Professional Staff Group Contact
• Contact with Care Co-ordinator
• Spell Suspensions
Unchanged tables
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Master Patient Index
Day Care Episode
Consultant Outpatient Episode
Acute Home-Based Care Episode
Mental Health Care Home Stay Episode
Day Care Facility Attendance
Mental Health Clustering Tool
Payment by Results Care Cluster
Social Service Statutory Assessment
SCT Recalls
ECT
Leave of Absence
AWOL
Reconfigured tables
• Disaggregated from Review table
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Employment
Accommodation
Primary and secondary diagnoses
HoNOS
Intervention (not mandated)
CPA Episode
• Staff table
– Replaces KWS and RC
• Team Episode
– Replaces CEP and PGEP
• Hospital Provider Spell and Inpatient Episode
– Replace IPEP
• Healthcare Professional Contact
– Replaces OPATT, KWCONT, CCONT and PGCONT
New to MHMDS
• Psychosis details (previously recorded on
FERN)
• Referral details
• Delayed Discharges (Unify2)
• Crisis Plan
• HoNOS variants and PHQ9
• Home Leave
• Self Harm (Count Me In)
• Restraint (Count Me In)
• Seclusion (Count Me In)
Amended tables
• Ward stays
– Added Security Level, Ward Gender, Ward Age, extra Care Intensity
• Clinical Team
– Now for national use and better team list added
• KWASS renamed to CCASS
– Staff ID added to link to Staff table
• RCASS
– Assignment dates and Staff ID added
• Review table
– Just about reviews; abuse question indicator and data linkage items
added
• Mental Health Act event
– Extra data items added to enable move to replace KP90
• SCT
– Expiry date added
Mental Health Bureau Service
V4
Gary Sargent – Bureau Services Manager
Why the change ?
•V3 v V4 :
– Standardisation
– Development and support
– Security
• Storage
• Access - Authentication
– Ease
– No installation
Open Exeter (OE)
OE Application Screen
Bureau Services Portal
MHMDS Homepage
MHMDS Homepage
Upload Screen
Upload Screen 2
View Results
Not For Submission
MHMDS Homepage
Submission History
Final Extracts
Contact Details
Exeter Helpdesk, [email protected],
tel. 01392 251289
Gary Sargent, Bureau Services Manager,
[email protected], tel. 01392 206916
Questions ?
Implementation and Submission
Schedule
Jo Simpson
Gary Sargent
Implementation Plan for v4 and Submission
Schedule
• Implementation timetable for v4
processing
– Subject to ISN
– Mitigation actions in reserve
• Way in which 2011/12 and 2012/13
submission timetable is structured
Implementation plan
Date
V4 developments
v3.5 BAU
Oct 2010
Submission to ISB
Nov - Feb
Design and development of new platform and
processes. Refinement and testing of requirements
specifications.
Feb 2011
NIGB Board – ISN?
February 2011
Assurance of data processing arrangements –
some volunteer trust involvement
March 2011
Open Exeter system delivered
April and May
2011
UAT
Piloting
Authenticate users of new system
Q3/4 final quarterly
deadline 06/05/2011
June 2011
System signed off and first FP window opens
(Q1P 2011/12)
Early adopters send data – pre deadline
processing
Final annual
submission
July – August
Development platform goes live
Receive MHMDS Index
Migrate MHMDS index
to new platform
Sept 2011
First v4 submission deadline
Q2/3 deadline
04/02/2011
Draft Submission Schedule
Last v3/3.5 submission Annual file 2010/11 – July 2010
No Q4R submission for 2010/11 – agreed with DH
Improving Access to Psychological
Therapies (IAPT)
Nick Bridges
Senior Business Analyst
Areas to be considered
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Why is the data set needed ?
Structure of the data set
Submission process
Status of the approval process
Key dates
Further planned developments
• Note: Applies to all providers of NHS Services,
including independent providers
Why is the data set needed ?
Support the NHS in delivering:
• NICE approved, evidenced-based psychological therapies for
people with depression and anxiety disorders
• Access to services and treatments for people experiencing
depression and anxiety disorders from all communities within
the local population, irrespective of age, gender, ethnicity,
diagnosis, socio-economic status, sexuality, faith or disability
• Increased health and wellbeing, measuring recovery and
meaningful improvements
Why is the data set needed ?
Continued
Support the NHS in delivering:
• Patient choice and satisfaction
• Timely access to services
• Improved employment, benefit, and social inclusion status
including help for people to retain employment, return to work,
improve their vocational situation and participate in the
activities of daily living.
Structure of the data set
• 50 item data set
• A relational database containing four tables:
– Person
– Referral
– Appointment
– Disability
• Called the ‘IAPT Intermediate Database (IDB)’
Submission process
Data flow:
– Provider data extract from local system
– Format into required IDB format
– Upload via Open Exeter web portal (using N3 connection)
– Central data processing – includes various derivations and calculations
– Data made available for download to providers, commissioners and the NHS IC
The is essentially the same as new MHMDS process, which will be discussed in detail this
afternoon.
But, are some differences from MHMDS processing:
– IAPT system will be in place from ‘summer 2011. MHMDS system is being
developed first
– No “assembly” process, only derivations and calculations.
– Commissioner data is pseudonymised
– Monthly submission
Status of the approval process
• Considered at ISB board yesterday !
• Outcome…..
Key dates
January 2011
ISB approval
March 2011
ISN issued
“Summer 2011”
IAPT data flow system
complete
“Summer 2011” to
March 2012
Voluntary data
submission
April 2012 onwards
Mandated submission
Further planned developments
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Detailed data set documentation will be issued, including:
Data set specification and guidance
• Information Standards Notice
• Specification of outputs of the processing, including
extracts and rules for derivations / calculations
undertaken
• Bureau Service processes
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KPI’s will initially run in parallel with data set and then cease
in 2013/14
Further planned developments
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Outcome based currency and tariff
• Investigation to be undertaken to determine relationship between
the IAPT data set and the mental health clusters:
– What the requirements are for deriving an IAPT currency and
tariff
– Whether any requirement exists to change existing MH clusters
/ clustering tool to incorporate IAPT.
• Additional items are likely to be added to the IAPT data set, such as
patient experience, duration of problem and previous treatments.
• Planned date for ISN is still to be finalised, but expectation is that
development closely maps to PbR agenda
• More details will be issued as the development progresses
Update on MHMDS Indicators and
Validations
Maria Short
Senior Information Analyst
Performance Indicators from
MHMDS…
Results from IC
http://www.ic.nhs.uk/services/mhmds/quarterly
Results from Department of Health
http://www.dh.gov.uk/en/Publicationsandstatistics/Pu
blications/PublicationsPolicyAndGuidance/DH_1091
46
Measures from CQC e.g. ‘Completeness’ of MHMDS
(09/10)
http://www.cqc.org.uk/periodicreview/nationalcom
mitmentsandpriorities2009/10/mentalhealthtrusts.c
fm
Performance Indicators from
MHMDS…
• Data produced from MHMDS for DH Performance
Indicators and published on IC website
• DH take data from here and publish with the rest of
their performance framework
• DH changed some of their definitions In Sept / Oct
2010
• MHMDS analysis NOT changed to reflect these
changes
• IC and DH working together to align these!
Performance Indicators from
MHMDS…
Main differences…
• DH state ‘reference period’
• HoNOS has age restriction on DH definitions
• AWOL definition counts ‘episodes’ rather than care
spells in DH documentation
We have been working with DH to change the
definitions to align with the current analysis so that
the indicators remain comparable for 2010/11. IC
will change analysis for 2011/12.
CQC measures…
• Quality and Risk Profiles:
http://www.cqc.org.uk/_db/_documents/QRP_data_so
urces_-_MH_v1.6b.pdf
• Q4 2009/10
• Measure ‘reversed’ compared to previous indicators
i.e. Numerator counts invalid / missing / default
records depending on data item
• Have a read!
Performance Indicators from
MHMDS…
http://www.ic.nhs.uk/services/mhmds/quarterly
Performance Indicators from
MHMDS…
http://www.ic.nhs.uk/services/mhmds/quarterly
**Detailed constructions on ‘Constructions tab’**
Performance Indicators from
MHMDS…
Just to clarify…
• ALL denominators use quarterly data only
• Numerators for 1,1a,2 and 2a look for the most
recent non NULL record over the last 12 months
(present and previous 3 quarters) for the people
identified in the denominator
• Numerators for 4 and 5 use quarterly data only
because the data items themselves are derived
during assembly (please see spec)
MHMDS Specification
Assembler detail
Derivations
Input tables and data items
MHMDS Version 4
Quarterly Data Quality Reports
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We need to review our MHMDS data quality reporting requirements
(as part of the development and implementation of MHMDS Version 4)
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Our review of the data quality reports is currently a work in progress
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We are looking for your thoughts/feedback on:
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New data items to report on
Data items to be removed from reports
Rules changes
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Please Email us at [email protected]
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Contact :
Suzie Brown
(Higher Information Analyst)
Community and Mental Health Team at the IC
History
• The MHMDS Data Quality Reports were originally published by DH
• Reports were subsequently develop by us at the IC as an interim
solution – pre SUS implementation
(Developed to look like DH reports)
• These reports were due to be produced within SUS
(once MHMDS was properly flowing)
• As such we were previously constrained by SUS rules.
(We tried to keep the rules as consistent as possible with the SUS rules where possible)
• Now in a position to take a fresh look at the reports
(with implementation of V4 and MHMDS no longer going into SUS)
Current Format
Excel File with 5 Worksheets:
1. Introduction
2. Notes
3. Results (shown as a %)
4. Results (numbers)
5. Rules
A reminder of what the reports currently look like:
Results (Shown as a %)
DQ Reporting Changes for MHMDS V 4
DQ Validation/Reporting will be a 2 Stage Process:
MHMDS Data Summary Report – produced on submission
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Produced for every file submitted (both primary and refresh)
Reports are produced as part of pre-deadline processing
3 Section at submission stage:
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Validation
Warning - Highlights issues which suggest incomplete/poor data
Diagnostics – reflect known information requirements
Quarterly MHMDS reports - based on processed data
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More categories than the diagnostic reports
As we currently produce but:
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With some data items removed
Some new data items added
Rules adapted as appropriate
To reflect V4 data changes and processing
Difference between Data Summary
Reports and Data Quality Report
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MHMDS Data Summary Reports
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Quarterly Data Quality Report
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Produced for every file at point of submission
Produced before any processing is done and any derivations are produced
Can only report on Valid/Invalid/Missing
Validates person identifiable data
Reports on data within the final refresh submission only – post processing and the production of
derivations.
Will not directly validate person identifiable data
(but may report on validity of such data where possible via derived data items e.g. Birthdate via
Age derivations)
Reports on Valid/Other/Invalid/Default/Other
(which is why we also call them VODIM reports)
There are likely to be differences in values shown in these reports for the same data
items for the same reporting period, because:
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Some people may end up with more than one MHMDS Record for the period
The denominator for the Quarterly Data Quality Reports is the MHMDS record, rather than
individual patients.
Therefore, where a patient ends up with more than one record – because they had more than
one care spell – or no record, because there was no activity – the denominators in the pre and
post deadline extracts will be different.
Main Considerations
• Maintain consistency with the rule/constructions
for different data quality reports/indicators
(a balancing act)
– Keep rules consistent with data quality reporting on
other datasets e.g. CDS
– Try to maintain consistency with DH Performance
Indicators and CQC Quality Indicators.
– Maintain consistency between Data Summary Reports
and MHMDS quarterly Data Quality Reports.
• Need to focus on key data items
Proposed Data Items to Remove From
the Quarterly Data Quality Reports
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PCT of Residence
Mental Health Care Spell End Code
CPA Level (at end of reporting period)
Occupation (CPA Care Co-ordinator)
Legal Status Classification (End of Reporting Period
PCT of GP Practice
Outpatient Attendance Consultant
All data items reporting on the number of ‘Contacts’
(e.g. with CPN, Clinical Psychologist etc)
Employment Status
Settled Accommodation Indicator
Quarterly Data Quality Reports
Rules Changes
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Rules need to be changed to account for how MHMDS v4 will look
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Other Changes
– Rules for Validity Commissioner code
• No longer validated against a ‘Commissioner List’
• It will be increasingly difficult to keep this list up to date
(due to changes to commissioning structure within the NHS)
• GP Practice Code will become more important
• Valid will include any codes in the correct format and an appropriate 1st character for a valid
ODS organisation
– Birth date (derived from age)
• If the age is over 120 then the data will be categorised as invalid
– Ethnic Category
• Z (not stated) to be categorised as ‘Other’ and not ‘Default’
• To stay consistent with the definition of ‘other’ previously mentioned
• Consistent with including Z in the numerator (valid/other) for other DQ indicators
New Data Items to Include in the
MHMDS V4 Data Quality Reports
• We will need to include all the new HONOS
scores which form part of MHMDS version 4
• We are looking for your input into what other new
data items should be included.
Where To Find the Current and Historic
Trust Level Data Quality Reports
Please take a look and let us know your thoughts
Friendly url: http://www.ic.nhs.uk/services/mhmds/dq
Down to detail: MHMDS v4 data processing
Jo Simpson
Senior Project Manager
Down to detail: v4 processing
• Why the change?
– Automated
– Transparent
– More secure
– No longer a temporary solution
– Detail required to support PBR and replace
other existing data collections (Fundamental
Review of Returns)
V3 v. v4 processing
• V3 produces:
– Flat file
– Aggregate counts from input data
– No reliable way of linking care pathways across
reporting periods
– Only outputs are pseudo data
• V4 will produce:
– Full detail of input database in 3 linked tables
– Enable linkage across reporting periods
– Be capable of producing patient identifiable record
level detail
Down to detail: v4 processing
• Populate IDB
• Upload IDB
• Validate IDB
• Pre deadline processing
SUBMISSION DEADLINE
• Post deadline processing
Processing MHMDS
• Populate IDB
– 45 tables
Processing MHMDS
• Populate IDB – inclusion rules for types of
table
– Single
– Event
– Episodes
Processing MHMDS
• Populate IDB
• Upload IDB
• Validate IDB
• Pre deadline processing
SUBMISSION DEADLINE
• Post deadline processing
Processing MHMDS
• Validate IDB
– Pass
– Fail
File rejected
File is processed
Report on failure – any of the following:
•The following tables were empty: (either or both of)
1 - MPI
5 - REFER
• X patients had an invalid NHS number (using v 3.5
validation rules)
• X patients had an invalid postcode (using v 3.5
validation rules)
• X patients had an invalid birth date (valid date, not
in future and with derived age at start of RP not
greater than 120)
•X duplicate NHS numbers in MPI Table
•X duplicate Local patient IDs (LPID) in MPI Table
Processing MHMDS
• Populate IDB
• Upload IDB
• Validate IDB
• Pre deadline processing
SUBMISSION DEADLINE
• Post deadline processing
Pre deadline processing
• Extract data
• Data item level derivations
• Flatten data from x linked tables to 3
Pre deadline processing: Extract data
different rules for different table types
• Items that only appear once in MHMDS
record:
– NHS number
– GP practice
• Items that appear many times (or not)
– Events – single date
– Episodes – start and end dates
Eg: Contacts extracted for Q1
Pre deadline processing…
• Extract data
• Data item level derivations
– Team Type for each Team Episode – derived
from unique Team ID (in Team Episode Table)
and matching record with Team Type in
CLINTEAM Table
…derivations
Pre deadline Processing…
• Extract data
• Data item level derivations
– From data in IDB, eg for each Team Episode a Team
Type derived from Unique Team ID and Team Type
allocated to that ID in the Team Table
– From reference data, eg LSOA from postcode
• Flatten data from 45 linked tables to 3
– by type: single, event or episode
Flatten data – eg: episode tables
View outputs of pre deadline processing
• Data summary reports
• Test extract
Data Summary Reports
• Validation results
• Warnings eg:
– X patients had an invalid gender code
– X patients were shown to be aged Under 16
at the start of the RP
– X patients had overlapping Referrals open
during the RP
• Diagnostics and other metrics
Data Summary Reports
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Diagnostics and other metrics:
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metrics to support the assurance of the data flow
• Number of patients
• Number of Event Dates
data quality metrics for some key data items
• x/y valid Gender
• x/y valid Organisation code GP Practice
(Where y = rows in record.csv)
an indication of the number of patients that fell in to the
denominator group for some known commonly used
indicators:
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people on CPA
people on CPA aged 18-69
Test extract
• Record csv
• Episode csv
• Event csv
Recap - Processing MHMDS
• Populate IDB
• Upload IDB
• Validate IDB
• Pre deadline processing
Review outputs and repeat until
SUBMISSION DEADLINE
• Post deadline processing
Post deadline processing
• Derive for each MHMDS record*
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MHMDS Person ID
MHMDS Spell ID
Spell Start Date
Spell End Date
Spell End Reason
MHMDS Record Number
* Consists of one row in record csv and multiple
rows in episode and event csv, linked on
MHMDS record id
Mental Health Care Spell
The spell is a patient level summary of all the mental
health care provided from the patient’s first referral into
the provider’s adult mental health services and ending
with a clinician’s decision to discharge the patient from
these services, or death.
The spell is unique to a provider / patient combination
and may span days, months or years.
• In version 4 MHMDS, the Spell Start and End dates will be derived
from Table 5: Referrals
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This table should contain a record for each external referral to the mental healthcare provider
for the patient. This should include referrals that were not accepted by the provider.
Where there are overlapping external referrals a date of discharge from mental health
service should be entered for the referral that finally closes the episode of care within the
provider.
Internal referrals with the mental healthcare provider should not be included.
Some other familiar MHMDS concepts
MHMDS record
The MHMDS record describes that part of a patient’s
care spell that occurred within a particular reporting
period. The full record of a care spell may consist of
more than one MHMDS record, if the spell has spanned
more than one reporting period.
Reporting period
A regular period of time described by a start and end
date. Each MHMDS record includes information relating
to a discreet reporting period. For version 4 processing
in 2011/12 the reporting period will to continue to be a
quarter and quarter 1 is from 01/04/2011 – 30/06/2011.
Log on and retrieve final extract:
• Record csv
• Episode csv
• Event csv
Documentation
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Current:
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Draft v4 Data standard (v 0.15 on web site:
http://www.ic.nhs.uk/services/mental-health/mental-health-minimum-datasetmhmds/specifications-and-guidance
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Updates on Changes to MHMDS processing (2)
In preparation:
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Guidance
IDB v4 and Release Notes
Mapping guide 3.5 to 4
Data Manual to include data inclusion rules and
derivation rules and specification for test and final
extracts
Any questions?.....
Contact: [email protected]
www.ic.nhs.uk/services/mental-health