Relieving distress, transforming lives

Data Collection in IAPT

The IAPT data standardMargaret Oates IAPT National Programme

Nick Bridges NHS Information Centre

Version 3

Introduction

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• Background/update– Data collection Principles– Update as at September 2011

• New processes for central data collection and reporting– The data standard– The central data repository– Data submission process

• Maintenance

• Inputs/ Outputs from the system – Work-in-progress

• Next steps &Timeline– Testing continuing. Submissions commence November 2011.

Mandated from April 2012

Central Principles for data collection

• Data collection is an integral part of delivering IAPT services

• Use a combination of patient-centred interviewing and outcome measurement tools

• Effective communication with patients• Patient involvement in decision making

• Provides tangible evidence of treatment progression• Effective inter-professional communication • Used by supervisors to review clinical work

Central Principles for data collection

• This primary use of data helps to Improve the quality of clinical interventions

• The IAPT toolkit first published in 2008 started to set out a common data set or clinical record

• IAPT data handbook provides guidance in data collection and the use of data

• Used by managers and commissioners to facilitate effective service performance

• Including monitoring monitoring equity of access and provision of NICE approved treatments

Update as at September 2011• Services continue to collect IAPT data set

– KPIs via Omnibus, guidance for 2011/12 at http://www.iapt.nhs.uk– Q1 will be published for the first time on NHS Information Centre web site

(precise location to be finalised)

• Information Standards Board (ISB) approval achieved in March 2011– IAPT data set approved as an National Operational Standard in April 2011.

Sets out how we will utilise IAPT data for secondary uses– Information Standard Notice (ISN) and IAPT Data Handbook issued– National Data Standard mandated from April 2012– Development of the IAPT central data collection system in-progress

• Data Standard Implementation project set up, co-working with NHS IC– Overseeing development of National processing and reporting system– From April 2012 the way we collect and report IAPT data will change!

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Focus of today

• The New IAPT data standard

• How it will be implemented in practice

• Changes to process and data flow

• Set expectations and provide a clear timeframe for development

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Information Standard• What do we mean by ‘Information Standard’?

– Output data standard

– Data items/ permissible values

– Mechanism for end-to-end processing

• Approval gained:– Information Standard Board (ISB)

– Review of Central Returns

– National information Governance Board

NIGB & Patient Identifiable Data• Patient identifiable data will flow centrally, however reports will be

aggregated and it will not be possible to identify a patient from the reports.

• S251 application approved meaning no need to seek explicit consent to use patient data.

• However, it is a legal responsibility to inform patients that their data will be used for secondary purposes, and for this reason the NIGB has asked us to provide patient’s with an explanatory leaflet and allow patients to ‘opt out’ from national reporting.

• The Programme has included an example leaflet in the new data handbook, this may be printed and distributed to patients.

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Changes since the MDS/Clinical record?

•Additional items - Compliance with Equality Act, and

- Policy development (e.g. veterans)

• Changes to existing items in line with - NHS Data Dictionary

- Definitional testing

• Local flexibility to collect additional data items

• Formal change and testing processes - Future updates likely after April 2012

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Development of the IAPT central data collection system

• Development of the IAPT central data collection system is near completion.

• Early system testing complete, currently conducting user testing. • The system is expected to go-live on 7 November 2011 to receive

October data.• From this time services are encouraged to submit data extracts.

This will help to test out processes and embed into practice in readiness for mandation in April 2012.

• It is important to emphasize that the provision of a patient-level reporting system will have significant impact on local information management practices

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Change to process• Every IAPT service will be expected to submit a full

data extract to the central data collection system on a monthly basis.

• 2011/12 is a transition year when services can make arrangements to change local IT systems and put in place procedures to process data.

• 2012/13 reporting via the IC website with parallel running of KPIs until assured of data quality from the new system

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How will the data standard support the IAPT Programme?

• Consistent framework for data collection and central reporting

• In-line with wider Information Strategy ‘Fundamental review of data returns’

• The provision of a central reporting system will allow secondary reporting and help us to better commission and manage services.

• IAPT national reports will be published on the NHS IC web site to support monitoring against IAPT quality standards including; equity of access, patterns of interventions and outcomes

• Allow benchmarking and make information accessible and transparent in a way that allows patients and the public to compare the range of interventions and outcomes achieved across services

• Local data quality reports available to help improve data quality

Data Structure and Data Flow

The Data Set and Submission• 50 data items (actually 53 as can have up to 4 therapy

types)• Data items grouped

– Patient table– Disability table– Referral table– Appointment table

• Defined permissible values• Defined validation rules which will lead to either warnings

or failures• Submitted as the IAPT Intermediate database (IDB)

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Data storage

• Patient identifiable data is submitted to the Bureau Service Portal. Its then– Processed– Held for a short period to allow local download– Deleted

• The Bureau Service Portal is not a data warehousing service

What data is held ?• The Bureau Service Portal will retain only five extracts at

any time:– the most recent primary and refresh submissions– the submissions from the previous fixed period– the primary submission from the period before that

• For example:– March primary ----- most recent submission– February refresh ----- most recent submission

• Plus– February primary– January refresh– January primary

Amendments since initial issueof ISN

• Removal of default W code from all outcome measures. No default code should exist for the outcome measures included.

• PHQ-9 – Alignment with PHQ-9 collection within MHMDS. Correction to ensure consistency of collection.

• Removal of attended or did not attend code ‘0 – Not applicable, appointment occurs in the future’. No requirement exists to connect future appointments.

• Generalized Anxiety Disorder Penn State Worry Questionnaire score range is incorrectly shown. Amended to cover the range 16-80.

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Amendments since initial issueof ISN

• Renamed British Armed Forces Indicator to Ex-British Armed forces indicator

• Removed from Ex-British Armed forces indicator codes ‘01 – Yes, currently serving (including reservists)’ and ’04 - Dependant of current serving member’. Both removed as serving personnel are not seen by IAPT services.

• Addition of default codes:– Ethnic Category– Sexual Orientation– Org Code of Commissioner– Appointment Purpose– Employment Support Indicated

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The intermediate database (IDB)

• 4 tables

• Microsoft Access format

• Defined structure which cannot be changed

• Support for all versions of Access since 2002

• Must not remove tables or amend structure of IDB as will lead to a rejection

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Collation of IDB

• Local data collection and validation

• Data extraction from local system(s)

• Format into required 4 table structure within an Access database, the IDB

• What data should be included ?

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Construction of IDB• Inclusion rules are:

– Referrals either opened in the period or already open at the start of the period

– Appointments linked to those referrals– Patients associated with those referrals– Disabilities associated with those patients

• It may be that not all referrals have appointments and not all patients have disabilities

• Rules are described in a separate document

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Submission• Submitted via Bureau Service Portal, provided by

Systems and Service Delivery Team of Connecting for Health

• Currently requires a N3 connection, but investigations are underway to determine if an alternative exists

• Requires organisation code provided by ODS service• Requires username and password to access

– Approval granted by local Caldicott Guardian– ‘Application form’ available from Connecting for

Health (link later)• Monthly submission of primary and refresh

submissions

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Fixed period processing• At any point in time the BSP will expect data

sets to be submitted relating to a specific period of time.

• For instance April’s data set will expect to be submitted in May.

• If March’s data set was submitted in May it would be processed as if it was April’s data, something which clearly should be avoided.

• A window of time exists in which a submission can be made – if it’s missed no option exists for later submission

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‘Not for submission’

• It may be that a situation arises whereby a data set needs to be run through the submission process for testing purposes.

• This is called a ‘not for submission’ submission. A user defined reporting period is able to be selected.

• The data set will not progress fully through the processing system and will not be used for national reporting.

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Submission and processing timescales

• Using April 2012 as an example….

• Window always opens on a Monday and closes on Friday. Open between 3 and 4 weeks, depending upon calendar for that month.

• Always closed for a week• Data set available by the following Monday, the same day window

reopens for next months submission

Window opens

Window closes

Closed for processing

Processed data set available

07/05/12 25/05/12 w/c 28/5/12 04/06/12

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Bureau Service Portal• In development • Plan is for portal to be in place from 7 November

2011 for voluntary submission• Process will essentially be:

– Login– Upload– Monitor– Retrieve data quality feedback and data downloads– Resubmit as required prior to window closing– Once window closes final data processing begins– Download processed data set for use locally by IAPT

providers, commissioners and the NHS IC

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Data quality reports

• Data quality reports will be supplied following submission• The data set will be subject to a series of validations to

test its integrity prior to it undergoing further processing• Validations can lead either to

– A warning– A failure

• A failure means the whole data set must be resubmitted• A warning means the data should be amended, but

processing can progress if it is not

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Validations - ExamplesWarnings• NHS number status indicator code is null when a

NHS number is provided• General medical practice code does not match a

valid ODS code

Failures• Local patient ID is null in any of the 4 IDB tables• Any date is not in valid format

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Processing stagesPre deadline processing• Various derivations which only utilise data

present within the current periods submission, such as age at referral.

Post deadline processing• Various derivations which utilise data from one

or more reporting period submissions, such as IAPT person ID (used to track patients across providers and submissions) and PHQ-9 first and last scores.

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Example:Submission period is April

April activity

Pre deadline

Post deadline

April activityMarch activityFebruary activity

Derivations such as age at start of reporting period, county, PCT of residence

Derivations such as First and Last score patient health questionnaire scores, First and Last social phobia inventory scores, Count of number of pure self help sessions

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Retrieving data sets• A user must login to the portal to retrieve a data set after

it is processed

• An email notification is sent to registered users once data set processing is complete

• Whilst the submission window is open a ‘pre deadline’ data set is made available following each submission. This allows for instance data quality checking. Made available only to providers.

• Once the submission window closes ‘post deadline’ data set is made available. This is the final data set used for reporting purposes. Made available to providers, commissioners and NHS IC.

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Who receives data sets?

Pseudonymised data set (non identifiable)

Patient identifiable data set

IAPT commissioners

NHS Information Centre

IAPT providers

• IAPT providers only receive data related to the patients they have treated

• IAPT commissioners only receive data related to the patients for whom they have commissioned a service

• The NHS Information Centre receives data for all patients seen by all providers

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Maintenance and future changes

Maintenance and possible new items• All changes will be overseen by the IAPT Outcomes and Informatics

Board

• Protected characteristics detailed in the 2010 Equalities Act 2010 i.e Marriage/civil partnership, Gender reassignment, Pregnancy, maternity

• Inclusion of scores to describe the results from a Patient Experience

Questionnaire.

• Revision to 'Sexual Orientation' data item value list. Code ’02 – Homosexual’ to be renamed to ’02 - Gay/Lesbian’.

• Items to Support Payment by Results

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Future Reporting

Future Reporting• The Information Centre is commissioned to

produce national reports• Initially will be limited to data quality reports• From April 2012 more extensive reporting

against IAPT quality standards• Standard reports currently being defined• Parallel running of the new system and KPI’s

throughout 2012

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Next Steps and Timeline

Next steps• Disseminate literature and guidance

• Check with local system suppliers

• Ensure resource in place to process/validate data

• Request the Intermediate Database

• Apply for access to the Bureau Service Portal

• ‘State of Readiness’ checklist

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Planned timescale

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Date Event

End September / early October

Issue of revised ISN and Standard Specification document

October Complete system testing

7 November Portal go-live

November – March Services submit data on a voluntary basis

November – March Services use data extracts and diagnostic reports to improve data quality

April 2012 Data submission mandated

From April 2012 Parallel running of both KPI and data set reporting systems

From April 2012 National reports will start to be published on the IC website

From April 2012 Establish user network

Further information• To obtain the Intermediate database (IDB) email

enquiries@ic.nhs.uk

• Register your interest to receive further information on the data set at

http://www.ic.nhs.uk/iapt

• Email queries to

iapt@ic.nhs.uk

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Further information• Bureau Service Portal access application forms

http://www.connectingforhealth.nhs.uk/systemsandservices/ssd/prodserv/vaprodopenexe1 – ‘Download the Caldicott Guardian Certificate’

Then at least one week later

2 – ‘Download the Bureau Service Portal Data User Certificate’

• Information Standards Board – IAPT Specification documenthttp://www.isb.nhs.uk/documents/isb-1520/amd-51-2010/index_html

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Questions, queries, uncertainties ?