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Annex 2 CENTRAL DATA REPOSITORY
Introduction
This document gives a high level description of the
capabilities and functionality of the Central Data
Repository (
CDR), which has been developed as part
of Have a Heart Paisley (
HaHP). The
CDR has been developed primarily as a
tool to facilitate the delivery of health care in relation
to coronary heart disease. The paper aims to address the
following:
1. Describe the capabilities of the
CDR in relation to other Scottish and
UK systems
2. Outline the potential gains and risks of the
CDR in Phase 2
3. Identify how those risks could be mitigated so that
the effectiveness of the project is not undermined
4. Clarify the individuals and staff groups who will
have access to identifiable data.
1
HaHPCDR Capability
The
CDR acts as a hub collecting and storing
data from systems based within primary care and secondary
care. It also imports demographic and hospital discharge
data from the Information Services Division (
ISD) and from the Community Health Index
(
CHI). Data is transferred on a regular
basis from these legacy systems, producing audit and
patient reports, which are updated daily and viewable
on-line. The
CDR provides comprehensive patient
information. It provides or has the following features:
- A single system containing all coronary heart
disease data to support the care of patients.
- Access to a single patient summary with the latest
data values within a core dataset.
- Access to historical data items
e.g. all blood pressures, cholesterols in
the system for an individual patient which can be
viewed over time in a graph or report.
- Access to all relevant General Practice
Administration System for Scotland (
GPASS) information for a specific
patient via a web browser.
- Access to all secondary care information, including
rehabilitation data via a web browser.
- Area-based comparisons, comparing current
GP practice details against the
average of all other practices.
- General Medical Services (
GMS) Contract indicator reports for
individual practices.
- The
CDR is a population database and has
the capability to be developed through the use of
relevant Read codes for any chronic disease management
or identification of target groups within the
population.
- The
CHD dataset was developed in Phase 1
and influenced the national core dataset for
CHD. It is compliant with
SCI Bronze and has been ratified by
ISD as holding national definitions
in the dataset and thus is also compliant with Scottish
Care Initiative (
SCI) diabetes and
SCI Store. The
CDRIT team is working with the national
IT subgroup in cardiology and any
further work will be in line with development of
SCI Silver and Gold.
- The
CDR is currently seeded by a
CHI download from the national
centre in Dundee and updated daily with a
CHI transactional file. When
SCI store is ready to seed other
NHS Argyll and Clyde systems it will
be possible to seed directly from the Store to the
CDR as the
CHI index is already there.
HaHP has shared
CDR development information with other
projects, however this has not been reciprocated. To fully
compare the functionality of the
CDR to other systems in Scotland
complete information is required. This is now being
addressed by
ISD. In the interim it is possible to
make comparisons from published articles on other systems
and five aspects of the
CDR system have been identified as
unique:
- A current population demographic database,
including deprivation categories
- Availability of
CCU (Coronary Care Unit) and general
cardiology inpatient data including investigations
(once Read Codes are finalised)
- Availability of cardiac rehabilitation data
- Community nursing palmtop data capture system
- Patient lifestyle data.
2 Benefits from the
CDR
The
CDR has the potential to deliver several
gains for stakeholders during Phase 2. The expected
benefits to each group are given in the table below.
Stakeholder | Benefits/evidence |
|---|
NHS Argyll and Clyde (
NHSAC) | Provides a platform to enable
future evaluation The
CDR can be used as a patient
tracking database that could facilitate
long-term patient outcome assessment at
practice or Paisley level. In addition, the
CDR can facilitate targeting
of
HaHP community-based
activity on specific groups/individuals and
enable ongoing monitoring and ex-post
evaluation of
HaHP service delivery |
Improves patient care and
outcomes Improved information will help enhance
healthcare delivery, which will in turn enhance
patient health outcomes. 25% of community
nurses stated that the
CDR had already impacted
positively on patient care. With fuller access
to the
CDR we expect that this
impact will be greater. |
Key learning generated through
IT development and
delivery Learning from the
CDR experience can be
applied locally and more widely in future,
where clinical
IT systems are being
developed/planned. |
GP practices | Information availability In a recent internal evaluation survey 75%
of
GPs stated that the
CDR contained information
not available elsewhere. Without the
CDR, immediate discharge
data and Secondary Care data from
CCU would be unavailable
electronically. |
New Information The
CDR will include patients'
lab test results and timeline charts for
GPs, which represents new
electronic information. All
GPs stated that such
information would be useful. |
Efficiency savings Electronic
CDR information will lead to
reduced time and effort expended in
GPs seeking patient data,
thus increasing
GPs' efficiency in treating
CHD patients. |
GMS Contract
facilitation CDR data is Read Coded then
sent to practices. All information is pre-coded
and is
GMS contract compliant,
requiring no administrative coding effort by
practice staff and assists data gathering
required by the new
GMS contract. |
Targeting
CHD Helps general practitioners focus services
on
CHD patients |
Community nursing team | Speed of access to patient
information Community nursing staff will not have to
wait for written communication (
e.g. hospital letters) |
Time saving During evaluation community nurses stated
that having the
CDR would certainly save
time in sourcing patient information |
Fuller information The
CDR contains information not
otherwise available to community nurses. |
Focuses community nursing
practitioners on
CHD Risk factor and behaviour information will
allow nurses to target existing health
inequalities. |
Patients | Improved care and service All the above benefits will contribute
towards more rapid, better-informed care
delivery for patients. Patients who are not
receiving appropriate therapy,
e.g. statins post
MI, or whose cholesterol is
not ideal, can be identified. |
| Improved health outcomes Better outcomes will derive from improved
care and service. Through the Rapid Alert
System the
CDR can alert patients by
mailshot to a medicine recall with an
explanation to allay anxiety. |
3 Potential Risks to the
CDR
A number of potential obstacles has been identified by
the
IT project team that could present
threats to achieving the potential benefits of the
CDR. The table below shows the
identified risks. The potential risks have been considered
against the risks that face
HaHP in Phase 2 and those that currently
face
NHSAC Cardiac Services
MCN in rolling out Phase 1. Should
HaHPCDR be rolled-out nationally it might be
expected that similar risks would face other
NHS Systems.
Potential risk | Solutions/safeguards | Extent of Risk |
|---|
1. Insufficient hardware in surgeries. (Relates to roll-out of Phase 1
only.)
| An extensive
IT upgrade programme was
recently carried out in primary care ensuring
that all surgeries met a minimum specification.
It has been confirmed that all practices in
NHSAC meet the required
specification. | Risk: Medium Impact: Low |
2.
GPASS practice but no
CDSS installed. (Relates to roll-out of Phase 1 only.) | The
IT project team is rewriting
the extraction routine which means that the
CDR will no longer be
dependant on
CDSS being installed. This
is currently being tested. | Risk: Medium Impact: Low |
3. Practices without
GPASS or
EMIS system. (Relates to roll-out of Phase 1 only.) | A new extraction method would need to be
devised. The number of such practices is likely to be
very small within
NHS Argyll and Clyde. The
picture in Scotland as a whole may be
different. | Risk: Low Impact: Medium |
4. Sufficiency of resources to support the
surgeries, given primary care support teams
limited resource. (Relates to roll-out of Phase 1 and
implementation of Phase 2.) | If the new extraction routine is implemented
the transfer of data will take place directly
between the
HaHP server and the
GP server; there will be no
program on the surgeries server. This will
reduce greatly the need for outside support as
most problems that arise could be fixed
remotely by the
HaHP system
administrator. The key resource need therefore is for
hardware purchase and installation - this has
been tackled through point 1 above. | Risk: Low Impact: Medium |
5. Changing working practices - Will the
practices support roll-out? (Relates to roll-out of Phase 1 and
implementation of Phase 2.) | A key thrust of the
CDR roll out is to minimise
the required change to working practices,
embedding the
CDR as seamlessly as
possibly using existing hardware and
communications channels. | Risk: High Impact: Low |
6. Staff - if we lost key staff this would
be a major risk to the project (Relates to roll-out of Phase 1 and
implementation of Phase 2.) | If this was implemented widely it would
become a corporate system and be supported by
the relevant
IT departments. This would
mean a greater knowledge of the system among
several more staff so that dependency on
certain people would be minimised. | Risk: Low Impact: Medium |
7. New versions of
GPASS are implemented which
affect the transfer of data (Relates to roll-out of Phase 1 and
implementation of Phase 2.) | GPASS have now registered
HaHP as a third party
supplier and will supply software updates of
GPASS to determine any
potential problems before the update goes
live. The
IT project team now has
extensive experience of responding to a
changing software environment and know the
pitfalls, thereby minimising unanticipated
disruption. The impact of new software versions may
cause
CDR information delay, but
no loss of data. | Risk: High Impact: Low |
8. Surgeries cannot link to the
RENVER network. Are there
resources available to implement a new
link? (Relates to roll-out of Phase 1 only.) | All surgeries appear to be on
BT Healthnet. If they are
not on the local network. This means that
connections can be easily set up. | Risk: Low Impact: Medium |
4 Access to the
CDR
Access to the
CDR is governed by procedures and
standards agreed by partners and set out in the
Security Protocols document (available on the
HaHP Register web-site). Access is
broadly structured as follows:
- All primary care health professionals have access
to their own patient-identifiable information via the
CDR. This is determined by the
surgery in which they work. Primary care health
professionals can access only their own patients'
data
- Secondary care professionals will only have access
to patient data for those patients who are currently
being cared for in their unit
e.g.CCU
- Researchers have access to anonymised data
only
- IT project team members have access
to patient-identifiable information within a controlled
and secure environment
- Other interested parties may apply to have access
to
CDR data, however, this will be
anonymised data only.
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