02/12/2012 1

Agenda

• DMICs and their place in the NHS • IG landscape• DMIC development project

– DMIC Network– DMIC Technical

02/12/2012 SEPHIG 5-Dec-2012 2

CSUs• CSUs will provide CCGs with external support,

specialist skills and knowledge, e.g. business intelligence services, clinical procurement services, business support services such as HR, payroll, procurement of goods and services and some aspects of informatics etc. to support them in their role as commissioners.

• CCGs have the freedom to decide which commissioning activities they do themselves, share with other groups or buy in from external organisations.

• Will be externalised in April 2016

• DMICs will collate commissioning intelligence pertaining to a number of CCGs, and provide this to other elements of the health service infrastructure including other CSUs.

• The structure of DMICs is varied; some are hosted by a subset of the CSUs, others operate as collaborative shared service across a number of CSUs .

DMICs

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What are DMICs?They are

The official NHS data processing and linkage orgsHosted by CSUs or operating as Shared Services

They are notVirtual organisations

CSUs and DMICs

Old-world OrganisationRelationships

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4 x PAN SHAs (e.g. Y52)10 x SHAs (e.g. Q38)151 x PCTs (e.g. 5QE)(50-ish PCT Clusters)8,500-ish GP Practices

New-world OrganisationRelationships

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1 x NHS Commissioning Board4 x Commissioning Regions (e.g. Y57)27 x Local Area Teams (e.g. Q69)22 x Commissioning Support Units9 x Data Management and Integration Centres211 x Clinical Commissioning Groups8,500-ish GP Practices

DMICs--

0aa

Geography of CSUs and DMICs

23 Commissioning Support Units

9 DMICs

9 Data Management Integration Centres

Stop press:0AF + 0AN = 0CENHS Cheshire and Merseyside

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Indicative

CCG/Practice mappinghttp://www.connectingforhealth.nhs.uk/systemsandservices/data/ods/ccginterim

How intelligence will be delivered

7

Care.data

HSCIC

DMIC x ~9

CSUX~23

CCGCCGsx~210

CCGLAPHX~150

Safe haven

Safe haven

National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public

National Data Feeds

Local Data Feeds

Small no CCGs doing own intelligence

DMICs may also provide datato wider stakeholders

Data FlowsTo enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets,a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH

Conformed data supplied back up to care.data

Provider (Local flows)

Wider Determinants

Alternative providers

3rd Sector

Provider National flows

Audits

ONS

National/ International Surveys

LATsX~27

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CSU/DMIC schedule

Apr2016

Apr2015

Apr2014

Apr2013

CSUs and DMICsoperational CSU s externalised

• What does DMIC operational mean? • Main issues are

– Operational readiness– Data Interoperability – both ‘up’ and ‘down’– Pseudonymisation– PbR rules– Industry liaison

What aboutIG?

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But first ..

NHS Act 2012 and IG• Tim Kelsey’s vision• Many practical issues unresolved in the Act

– Section 251 needed to support flow of PID outside the HSCIC– PCTs do much more than just commissioning (e.g. Urgent Care)– Patchy implementation of pseudonymisation

• Sharing data and linking it together will improve– whole system understanding– enable pathway monitoring across health and social care– identify system interdependencies – facilitate correlations between treatments, experience and

outcomes

Section 251 - sets aside the common law duty of confidentiality for [direct] medical purposes •where it is not possible to use anonymised information and •where seeking individual consent is not practicable.

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Commissioning Intelligence Model

The business intelligence needs to support health commissioners can be framed as a set of questions that need help answering. •How healthy?•What’s really happening?•How much?•How good?•Are Providers delivering?•Could things be better?•Have we made a difference?•What are our future plans

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The seven scenarios where Commissioners need access to PID 1.Integrated care and monitoring services including outcomes & experience requires linkages across sources2.Commissioning the right services for the right people requires the validation that patients belong to CCGs and have received the correct treatments3.Aspects of service planning and monitoring on geographic data basis require postcodes for certain type of analysis4.Understanding population and monitoring inequalities5.Target support for patients and population groups at highest risk requires data from several sources linked together6.Specialist commissioning is commissioned outside local areas and can require wider discussions about individual patients and their associated costs7.Ensuring appropriate clinical service delivery and process requires access to records

Commissioning activities requiring PID

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Caldicott2 review and need for interim position

• It is agreed by all that there is a need for a holding position

• To enable commissioning, PID including NHS no, DOB, Postcode data needs to flow to DMICs – The DMICs need to have similar powers and controls to

the HSCIC to process data– In order for processing of PID at DMICs to be undertaken

legally, a change in legislation will be required– Legislative changes can not be achieved by April 2013

• Caldicott2 report expected Jan/Feb 2013• DMICs need to be operational in April 2013

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Proposed organisational access to PID for commissioning uses

13

LAPHX~150

CSUX~23

DMIC x ~9 safe haven

CCGsx~212

HSCIC Safehaven

Organisation Require PID flows

Clinicians

Exceptions requiring controlled access to PID as per previous slideFor data linkage & validation

for national flows (by small no defined roles)

For linkage & validation between national and local flows(by small no defined roles)

Identifying at risk patients

Small number roles which can not be done without use of PID via role based access

Access to postcode level data via role based access

Access to PID data

Justification

Facilitates wide use of quality linked de-id data for commissioners

Facilitates wide use of quality linked de-id data for wider agencies

Enables types of Commissioning (as per slide 12)

Enables geographic analysisTo monitor at risk populations

Enables proactive patient care

Patient level de-identified data suitable for all aspects of work May require PID if do not use CSU or LAPH

LATSX-27

Small number roles which can not be done without use of PID via role based access

Enable aspects of service monitoring

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Perso

nal

Observa

tion

DMIC interim options

• What are the options?– Do nothing - illegal– Send all data flows to

HSCIC - impracticable– DMICs part of NCB &

apply for section 251 - limiting

– DMICs linked with IC + IC special powers – continuity

• General agreement that DMICs need PID

• NCB will not allow anything illegal

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• Continuity option may still need section 251

How intelligence will be delivered

15

Care.data

HSCIC

DMIC x ~9

CSUX~23

CCGCCGsx~210

CCGLAPHX~150

Safe haven

Safe haven

National Bodies incl: NHSCB (regional teams), PHE, Research, Commercial, CQC, Monitor & Public

National Data Feeds

Local Data Feeds

Small no CCGs doing own intelligence

DMICs may also provide datato wider stakeholders

Data FlowsTo enable the widespread use of de-identified data in the NHS, consistent data quality, validation checks & linkage need to be undertaken. Due to the vast amount of locally defined unconformed datasets,a small number of DMICs have been proposed to undertake the data processing on behalf of local CCGs, CSSs and LA PH

Conformed data supplied back up to care.data

Provider (Local flows)

Wider Determinants

Alternative providers

3rd Sector

Provider National flows

Audits

ONS

National/ International Surveys

LATsX~27

02/12/2012

DMIC development

• DMIC network and technical groups meet monthly• DMIC Network concerned with authorisation

– CP2 (Jun 2012) authorised 9 DMICs to proceed– CP5 (Feb 2013) will accredit DMICs as viable– Liaison with industry groups– ISO standards

• DMIC technical focusses on service delivery– Interoperability

• SUS• Customers

– Pseudonymisation

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DMIC Technical issues• Access to SUS extracts

– DME marts proposed – db 2 db data transfer– IG issues to resolve

• Input to DMIC – six data feeds supportedSUS inpatientsSUS outpatientsSUS accident&emergency

• Output from DMIC data processing in the form of Logical Data models– 3 logical models submitted to standards (IP, OP, A&E)– 3 more under discussion (GP, Mental health and Community)– 3 more proposed for 2013-14 (111/OOH, Ambulance and Referrals)

GP dataCommunityMental health

• Common Pseudonymisation policy• Re-identification and web

service• Common algorithm• Simple implementation in

advance of Caldicott2

One possible interoperability set-up

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Data service in 2013-14• Reality check

– Not everything will happen by April 1st 2013– SUS will not shut down PCT SUS feeds– New organisation hierarchy on some national systems

from January– CCG IG function not fully operational– Many CSU BI systems will not be ready by April 1st 2013

• Therefore, – BAU systems will continue to operate through early part of

2013-14– IG guidance will gradually be applied– The dust will settle as newly authorised organisations take

on their statutory duties 02/12/2012 18

Thank you for listeningAny questions?

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Hand-out - commissioning activities requiring PID

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